vspВопросы современной педиатрииCurrent Pediatrics1682-55271682-5535Издательство «ПедиатрЪ»10.15690/vsp.v24i3.2901vsp-3772Research ArticleОБЗОР ЛИТЕРАТУРЫREVIEWСубапоневротическое кровоизлияние у новорожденных: обзор литературыNeonatal Subgaleal Hemorrhage: Narrative Reviewhttps://orcid.org/0000-0002-4222-4104КиосовА. Ф.KiosovAndrey F.

Киосов Андрей Федорович - кандидат медицинских наук, доцент кафедры детских болезней с курсом неонатологии.

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kiosow@mail.ruПервый Санкт-Петербургский государственный медицинский университет им. акад. И.П. ПавловаРоссияPavlov First Saint Petersburg State Medical UniversityRussian Federation202521072025243140145Copyright © Киосов А.Ф., 20252025Киосов А.Ф.Kiosov A.F.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vsp.spr-journal.ru/jour/article/view/3772

Субапоневротическое кровоизлияние (СК) — скопление крови между эпикраниальным апоневрозом и надкостницей костей черепа. Представляет собой флюктуирующее образование в области волосистой части головы, которое распространяется через линии швов черепа. У детей с СК возможно развитие анемии, гипербилирубинемии, болевого синдрома и судорог. Новорожденные с СК могут нуждаться в наблюдении и лечении в отделении реанимации и интенсивной терапии. При распространении СК на область орбит возможны офтальмоплегия, птоз века, нарушение зрения. При больших СК кровь проникает ниже скуловой дуги, поэтому у ребенка могут возникать затруднения дыхания, апноэ, некрозы мягких тканей. В субапоневротическом пространстве у новорожденных может накапливаться до 250–300 мл крови. Поэтому при больших СК возникают гиповолемия, артериальная гипотензия, коагулопатия, геморрагический шок. У детей с СК возможны субдуральные гематомы, разрывы намета мозжечка, переломы костей черепа. Среди младенцев с СК, поступивших в отделение реанимации, летальность составляет 12–14%. Дифференциальная диагностика проводится в отношении кефалогематом и большой родовой опухоли (caput succedaneum). Ультразвуковое исследование позволяет дифференцировать состояния, определить дальнейшей тактику инструментальной визуализации и ведения пациента. Технику проведения ультразвукового исследования у детей могут освоить неонатологи, анестезиологи-реаниматологи, педиатры. Небольшие СК рассасываются самостоятельно в течение нескольких недель. При больших кровоизлияниях может потребоваться оперативное лечение из-за высокой опасности развития осложнений (нагноений, некрозов, кальцинаций и нарушений зрения).

Subgaleal hemorrhage (SH) is a blood pooling between epicranial aponeurosis and skull bones periosteum. It is a fluctuating mass on the scalp spreading through the cranial sutures. Children with SH may have anemia, hyperbilirubinemia, pain syndrome, and seizures. Newborns with SH may require monitoring and treatment in intensive care unit. Ophthalmoplegia, eyelid ptosis, and visual impairment are possible if SH is spreading to the orbital region. In case of large SH, blood can penetrate below zygomatic arch, thus, the child may have difficulties with breathing, apnea, and soft tissue necrosis. Up to 250–300 ml of blood can accumulate in subaponeurotic space in newborns. Therefore, large SH may lead to hypovolemia, arterial hypotension, coagulopathy, and hemorrhagic shock. Children with SH may have subdural hematomas, cerebellar tentorium ruptures, skull fractures. Mortality rate among infants with SH admitted to intensive care unit is 12–14%. Differential diagnosis should be performed with cephalhematoma and large caput succedaneum. Ultrasound examination allows us to differentiate these conditions, determine further tactics of instrumental imaging and patient management. Neonatologists, intensivists, and pediatricians can master the ultrasound examination technique in children. Small SH can reabsorb on their own within few weeks. Surgical treatment may be required in case of large hemorrhages due to the high risk of complications (suppuration, necrosis, calcifications, and visual impairments).

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The authors declare that there are no conflicts of interest present.