腦室內出血(IVH)
腦室內出血（IVH）是指腦部內的空腔有出血的情況。出生週數較早、出生體重較輕或出生過程較艱難的嬰兒會有較高的機會出現腦室內出血。[1][2]
腦室內出血一般在出生後72小時內發生。[3] 醫生會透過腦部超聲波掃描來診斷出血的位置，並將其嚴重程度分級。如果出血只屬輕微，嬰兒可能不會出現任何症狀。可是在嚴重的出血下，嬰兒可能會出現意識改變、呼吸困難、心律和血壓不穩，甚至會有抽搐。嚴重的出血也可能導致腦壓增高，亦可引致腦室外的周圍出血。這些情況都有機會危及生命。
腦室內出血的治療一般以支援性為主。醫生會根據嬰兒的臨床情況先將他們穩定下來。有些嬰兒可能需要接受輸血；有需要時，他們亦可以透過服用藥物來控制抽搐。若腦壓在嚴重出血後持續偏高，外科醫生可能會為嬰兒進行手術。腦室內出血的嬰兒需要定期透過超聲波掃描來跟進出血的情況。
大部分輕微的腦室內出血都會隨著時間而逐漸消退，這對嬰兒將來的發展一般不會造成太大的傷害。然而，嚴重的腦室內出血不但會危及性命，更為倖存的嬰兒帶來長遠的挑戰，特別是大小肌肉的發展；有些嬰兒還可能出現大腦麻痺和學習困難等。[4]
-撰寫自劉凱盈醫生
威爾斯親王醫院兒科
駐院醫生
Intraventricular haemorrhage (IVH)
Intraventricular haemorrhage (IVH) describes a condition where there is bleeding in the ventricles of the brain. It predominantly affects preterm babies. We see that babies with a lower gestational age, lower birth weight or a stormier perinatal period generally have a higher chance in developing IVH.[1],[2]
IVH usually occurs within the first 72 hours of life.[3] An ultrasound scan of the brain will be done to grade the severity and locate the site of bleeding. Babies may not develop any symptoms if the bleeding is mild. However, in severe cases, babies may present with altered consciousness, difficulty in breathing, unstable heart rate, blood pressure and seizures. Severe bleeding could also cause increase the pressure to the brain and bleeding into surrounding parts of the brain. These conditions can be life-threatening.
The treatment of IVH is mainly supportive. Doctors will stabilize the baby according to his / her condition. Some babies will require blood product transfusion. Medications can also be given to control seizures if any. Surgeries may be performed in babies whose brain pressure remains high after severe bleeding. Follow-up ultrasound scans will be done to monitor for any increase or resolution of the bleeding.
Most babies with mild IVH will have resolution of the bleeding with time, it may not do much harm to their long-term development. Severe bleeding can be life-threatening, and survivors may face long-term challenges especially in motor development; some may also develop cerebral palsy and learning difficulties.[4]
Written by Dr. Sharon Lau
Resident, Department of Paediatrics
Prince of Wales Hospital
Reference:
1 Stoll BJ, Hansen NI, Bell EF, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Paediatrics 2010; 126:443.
2 Ballabh P. Intraventricular haemorrhage in premature infants: mechanism of disease. Paediatric Research. 2010 Jan;67(1):1-8.
3 Levene MI, Fawer CL, Lamont RF. Risk factors in the development of intraventricular haemorrhage in the preterm neonate. Arch Dis Child 1982;57(6):410–7.
4 Beaino G, Khoshnood B, Kaminski M, et al. Predictors of cerebral palsy in very preterm infants: the EPIPAGE prospective population-based cohort study. Dev Med Child Neurol. 2010; 52:e119.