Tid Bits....& New Date...

Here is a little bit of info about Danielle and her Brain Hemorrhage at Birth resulting from her Prematurity. The developing brain of a preterm infant is also vulnerable to injury. There are several types of problems that affect the preemies brain.

* The surface of the brain develops quickly between weeks 24 and 40, and so there is a big difference between the brain of a preemie born less than 28 weeks gestation and a baby born later than 32 weeks. {Danielle was born at 24 weeks}
* The germinal matrix is near the ventricles and makes new neurons and cells that support them, it is also called the subependymal region. If you have ever seen a picture of a brain, you will see it has many wrinkles or grooves, that look like folds, these folds or wrinkles increase the surface area of the brain and help it function more powerfully and efficiently. In other words, the folds are very important for learning and intelligence. The process of folding occurs between 24 and 40 weeks gestation so a premature baby born around 24 weeks gestation will have a brain that will look smooth on the surface, whereas a baby born at term would have a brain with grooves and folds. Because a preterm infant is born during a time the brain is undergoing important developmental changes, it is vulnerable to injury. {Danielle had a brain injury at birth. A grade III on the right and a grade IV Brain Hemorrhage on the left.}
*A brain hemorrhage, or bleeding within a premature infant's brain are of 2 types, they are intraventricular and germinal matrix haemorrhage's. The preterm infant has a number of physiological features that make it vulnerable to brain injury. Blood vessels in the germinal matrix carry a large amount of blood and are very fragile. These fragile vessels in the inner part of a preemies brain are vulnerable to changes in blood flow. The events leading up to and following preterm birth can affect the blood flow causing the vessels to break and bleed. If these vessels rupture, the bleeding occurs in or near the ventricles, the blood initially accumulates in the germinal matrix and may spill into the neighbouring ventricle.
*Another factor that can place a baby at risk for IVH is related to the heart. The persistence of patent ductus arteriosus (PDA) can alter brain blood flow and circulation considerably. Patent ductus arteriosus can cause increased stress on an already immature respiratory system and can lead to a relative reduction in brain blood flow. If the ductus in then closed, either naturally, pharmacologically, or surgically after several days, there can be an increase in cerebral blood flow. These changes or fluctuations in blood flow can result in bleeding within the germinal matrix. {Danielle had a PDA at birth that was closed pharmacologically (with medication).}
*Grade 3 IVH refers to extension of blood into the ventricular system, filling more than 50% and usually accompanied by ventricular dilatation. Grade 3.
*Grade 4 IVH is not actually intraventricular hemorrhage at all, but rather refers to the periventricular hemorrhagic venous infarction that occurs with obstruction of blood flow through the periventricular terminal vein. This means a hemorrhage outside the ventricles, in the white matter of the brain. {Danielle is still very venous at the base of the 4th ventricle, which should have gone away by now.}
*Preemies less than 1,000 g (2lbs) or less than 28 weeks - 50-60% chance of developing IVH. 10% have a chance of developing a grade 4.
*Hydrocephalus is called 'water on the brain' which means there is an abnormal amount of cerebrospinal fluid in the brain and brain ventricles. Following and intraventricular haemorrhage the blood clots can block the drainage system of the brain or scar the brain membranes. This can result in the increased pressure inside the skull and enlargement of the head. {Danielle has hydrocephalus and her first shunt on the right was placed on the right side to help correct this.}
****New Surgery Date****
Danielle's surgery was moved up one day to April 15th. I spoke to the U on Friday and the surgery is described as Posterior Fossa Craniotomy.
The goal of the surgery is to remove the pressure on the cerebellum and brain stem and in the 4th ventricle going in the lower part of the skull in an area known as the posterior fossa.



Danielle will have a special MRV (Magnetic resonance venography) scan two weeks prior to surgery that will help him see where she is venous. It is an MRI study of the blood vessels in her head. Which will be used to assess the abnormalities in the blood vessels. We will know a lot more after this scan and it will help her Neurosurgeon finalize his plans for surgery, so we know full well this scan could change things for her surgery as well.
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The past week has been pretty good. Danielle has not shown that she is in any amount of pain. A couple days she was a little quiet and didn't want to eat much but we do not think that was a result of pain. This past Thursday we began in home care again and she seems to be adjusting well.
We have seen smiles most days and that is a sign that she seems to be doing and feeling well.

Occasionally we have seen the pouty face. Mostly when she wants to be held, or is startled...this one we actually captured when she was asleep.

We still continue to learn life lessons from her daily. She is by far the strongest most courageous little girl I know. What she has been thru and continues to battle on a daily basis, she still manages to put a big smile on her face and trudge thru.

We give extra hugs and kisses right now, she so needs and deserves them!