Intracranial Pressure In Newborns: Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Intracranial pressure in newborns

The diagnosis of "intracranial pressure" in a newborn baby, made by a pediatric neurologist, baffles the parents of the child. They do not know what can be done in this case, and, most importantly, what consequences this pathology can give to the baby's health.

Content:

• What does increased intracranial pressure mean?
• Causes of increased intracranial pressure
• Symptoms of intracranial pressure in children
• Complications and consequences
• Diagnosis of intracranial pressure
• Treatment of intracranial pressure in children
• Conclusion

What does increased intracranial pressure mean?

It is much easier to navigate in the peculiarities of pathology, knowing the anatomy of the brain. The brain is protected by several membranes, the space between which is filled with cerebrospinal fluid. The system of interconnected ventricles is filled with the same fluid, which, together with the membranes of the brain, creates a kind of protection against possible injury and concussion.

If the volume of cerebrospinal fluid exceeds the permissible norm, it puts pressure on the structures of the brain. Increased intracranial pressure leads to negative consequences and sensations.

Is an increase in intracranial pressure always a pathology? Intracranial pressure in a baby can increase for a short time during coughing, stress, crying, during bowel movements, while breastfeeding while feeding. Everyday episodic pressure surges are not at all dangerous for the child, however, if this symptom is permanent, examination and treatment of the pathology is required.

High intracranial pressure - diagnosis or symptom? This is not a separate disease, but a symptom of a malfunction of certain systems and organs of the child's body. A detailed diagnostic examination will help to identify the underlying disease that affects the formation of a persistent rise in pressure.

Causes of increased intracranial pressure

Diseases accompanied by increased intracranial pressure:

• Brain tumors of any etiology - changes in brain structures and a growing tumor put pressure on its tissues;
• Meningitis - a change in the properties of cerebrospinal fluid in the direction of viscosity leads to a violation of its outflow and the formation of cerebral edema;
• Encephalitis - an inflammatory process in the cerebral cortex leads to swelling of its tissues;
• Toxic damage - leads to edema;
• Hydrocephalus - violation of the outflow of cerebrospinal fluid along the cerebrospinal fluid pathways with this pathology is violated, exceeding the permissible volume of cerebrospinal fluid leads to an increase in pressure;
• Genetically determined congenital pathologies of the functioning of the brain;
• Traumatic brain injury - edema as a result of a brain injury, the possible formation of a subdural hematoma provokes an increase in the volume of brain tissue;
• Hemorrhage in the structure of the brain - the focus of hemorrhage takes up a certain volume and squeezes the nearby tissues;
• Edema of the brain is a consequence of intrauterine fetal hypoxia or hypoxia during childbirth;
• Closing the “fontanelle” too quickly - earlier fusion of the skull bones with a growing brain leads to a gradual increase in pressure.

Most cases of intracranial hypertension in children are caused by birth trauma and pregnancy pathologies (intrauterine infection, fetal hypoxia), as well as hydrocephalus.

Symptoms of intracranial pressure in children

A variety of symptoms of high blood pressure can be supplemented by symptoms of the underlying disease that provoked the pathology. The main factor is the division of signs of pressure into groups - the age of the child, because the presence or absence of “fontanelles” on the baby's skull is of great importance. Finally, the bones of the skull usually do not grow together until a year, after a year the “fontanelles” are already closed. This factor directly affects the manifestations of pathology.

Symptoms in young children

It is difficult for an infant to diagnose; you have to rely on visual signs:

• Behavior restlessness, tearfulness. Usually a child with intracranial hypertension is calm during the day, and in the evening and at night he is worried, cries and is capricious. This is due to the fact that when the baby is in a horizontal position, the outflow of cerebrospinal fluid is slowed down, the veins are overflowing, which leads to an increase in the volume of cerebrospinal fluid and its pressure on the brain.
• Sleep disturbances, restless sleep, difficulty lying down. The reason for this behavior is similar to the factors described above.
• Regurgitation, nausea, vomiting. This symptom may be physiologically justified because swallowing air while sucking or overfeeding can cause these symptoms. Meanwhile, such symptoms may well appear due to irritation of the structures of the medulla oblongata, as a result of increased intracranial pressure.
• Increase in the size of the skull. As a result of hydrocephalus, which occurs due to the accumulation of cerebrospinal fluid in the cavities of the brain, “fontanelles” swell, the bones of the skull diverge, its frontal part increases, and the child's head becomes disproportionate.
• Well-defined venous network under the scalp. Excessive expansion of the saphenous veins due to stagnation of blood and excessive filling of the venous network with it, makes the veins visible.

• Graefe symptom

  It is expressed in uncontrolled downward movements of the eyeballs, when a strip of sclera is visible between the iris of the eye and the upper eyelid. The symptom is called "the symptom of the setting sun", manifests itself as a result of disruption of the oculomotor nerves due to intracranial hypertension or birth trauma.

• Refusal to eat. Sucking movements increase the already increased intracranial pressure, which leads to negative sensations in the child. The pain is so severe that the child refuses to eat and loses weight.
• Delay in psycho-emotional and physical development. The symptom occurs due to the negative impact of pathology on the baby's body and a lack of nutrients.

Symptoms in older children

• Nausea and vomiting due to irritation of the structures of the medulla oblongata with an excessive amount of cerebrospinal fluid, vomiting does not bring relief;
• Pain behind the eyeballs due to the pressure of the cerebrospinal fluid on the orbit area;
• Complaints of children for double vision, the appearance of flashes and ribbons in front of the eyes, arising from irritation of the optic nerves;
• Headaches of high intensity, worse in the evening and at night;
• Sleep disturbances, anxiety;
• Behavior disorders - tearfulness, irritability.

Complications and consequences

If hypertension is not treated, the following complications may occur:

• Disorders of mental development, its delay;
• Development of epileptic syndrome;
• Deterioration of vision;
• Development of ischemic or hemorrhagic stroke;
• Disorder of consciousness, impaired respiratory activity, feeling of weakness in the arms and legs due to infringement of the cerebellum.

Diagnosis of intracranial pressure

To determine the correspondence between the norm and the pathological excess of the indices of intracranial hypertension, a spinal puncture was previously used - an invasive method, the implementation of which is associated with complications. Currently, there are many alternative diagnostic techniques.

At the beginning of the examination, you need to visit a pediatric neurologist to determine the deviation in the formation of reflexes, the size of the baby's head, the presence of "fontanelles", and the diagnosis of Grefe's symptom. The doctor is interested in the characteristics of the child's sleep and wakefulness, appetite, behavior.

During a visit to an ophthalmologist, the doctor will be able to see the symptoms of hypertension:

• Fundus changes;
• Puffiness and bulging of the optic nerve head;
• Arterial spasm.

During neurosonography, the following signs of increased intracranial pressure can be detected:

• Increased ventricular size
• Deformation of brain structures;
• Increased interhemispheric fissure;
• The presence of an atypical formation in the brain;
• Displacement of brain structures.

Neurosonography, or ultrasound of the brain, is performed before the “fontanelles” are closed, that is, up to a year.

How often should neurosonography be performed? In accordance with the order of the Ministry of Health of the Russian Federation, the study is carried out during the first half of life at least 3 times - every 1, 3, 6 months. Even if the indicators were normal during the first study, it must be repeated. The dynamics of the child's development is changing, so it is better to notice the problem in time and begin correction. If there are indications, neurosonography is performed additionally before closing the “fontanelles”.

Is this procedure harmful? No, ultrasonic radiation is safe for a child, and its benefits are undeniable.

And if the spring has already closed? In this case, the examination by a neurologist is complemented by magnetic resonance imaging or computed tomography.

Treatment of intracranial pressure in children

The choice of a strategy for treating high blood pressure depends on the characteristics of the course of the underlying disease.

Hypertension treatment methods:

• Optimization of sleep, feeding, wakefulness of children;
• Introduction to the mode of moderate physical activity (swimming);
• Long walks;
• The use of diuretics - triampur, diacarb;
• The use of nootropic drugs that increase blood circulation in the blood vessels of the brain - cavinton, pantogam, piracetam, nicotinic acid;
• Use of neuroprotective agents - glycine;
• Prescribing sedatives;
• Physiotherapy procedures;
• Conducting neurosurgical operations in the presence of tumors, violation of the anatomy of brain structures.

Ventriculo-peritoneal shunting in hydrocephalus very effectively improves the child's condition. During this operation, a shunt is placed between the ventricles of the brain to drain excessive amounts of cerebrospinal fluid into the abdominal cavity.

Conclusion

Do not think that increased intracranial pressure in a child cannot be cured. Modern possibilities of medicine and pharmacology, competently performed therapy and surgical treatment will help to recover without consequences for the child's body. It is important to carefully follow the doctor's prescriptions and trust him.

Comprehensive treatment in each specific case is prescribed depending on the individual characteristics of the child, and is under medical supervision.

Intracranial pressure in infants is not inherited. It is caused by the pathological course of pregnancy and childbirth.

Author of the article: Sokov Andrey Vladimirovich | Neurologist

Education: In 2005 completed an internship at the IM Sechenov First Moscow State Medical University and received a diploma in Neurology. In 2009, completed postgraduate studies in the specialty "Nervous diseases".