[Ischemic and hemorrhagic cerebral vascular accidents in the full-term newborn infant. Study protocol and therapeutic directions].
OBJECTIVE
Ischemic and hemorrhagic cerebral vascular accidents in newborn are an important component in the determination of neonatal morbidity and mortality. The frequency is 1-2% for each condition. The etiopathogenesis is closely related to hypoxemia and ischemia in ischemic accidents and to traumatic birth in hemorrhagic accidents. Identification of the forms of clinical presentation with the help of neuroimaging and other complementary diagnostic investigations is the first step before prophylactic and/or therapeutic treatment.


METHODS
Based on integrated physiopathological models, we establish the anatomopathological patterns which permit the definition of clinical forms of hypoxia-ischemia, and also establishment of the topographical classification of hemorrhages according to their site, as subarachnoid, subdural, intraventricular, cerebellar or intraparenchymatous, together with their pathological study, clinical presentation and diagnosis of lesions at each of these sites, emphasising the importance of neuroimaging and the therapeutic possibilities.


CONCLUSIONS
The diagnostic approach that we suggest allows etiopathogenic and therapeutic decisions which determine improved prognosis and often even cure at the present time. The basic principles of a therapeutic protocol should be based on monitorization of the newborn baby during the acute phase. There should be close observation of the arterial blood pressure, temperature, biochemical parameters, treatment of seizures and the possibility of correction within the 'therapeutic window' of reperfusion and subsequent recovery of cerebral tissue involved by using mechanisms of neuroprotection.
Campos-Castelló
J
J
Servicio de Neuropediatría, Hospital Clínico Universitario San Carlos, Madrid, España. jcampos@hcsc.insalud.es
Canelón de López
M S
MS
Santiago-Gómez
R
R
D000465:Algorithms; D002526:Cerebellar Diseases / Q000150:complications / Q000209:etiology / Q000628:therapy; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000150:complications / Q000209:etiology / Q000628:therapy; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000145:classification / Q000209:etiology / Q000628:therapy