Intracranial hemorrhage in full-term newborns: a hospital-based cohort study

Abstract

IntroductionIn recent years, intracranial hemorrhage (ICH) with parenchymal involvement has been diagnosed more often in full-term neonates due to improved neuroimaging techniques. The aim of this study is to describe clinical and neuroimaging data in the neonatal period and relate imaging findings to outcome in a hospital-based population admitted to a level 3 neonatal intensive care unit (NICU).MethodsFrom our neuroimaging database, we retrospectively retrieved records and images of 53 term infants (1991–2008) in whom an imaging diagnosis of ICH with parenchymal involvement was made. Clinical data, including mode of delivery, clinical manifestations, neurological symptoms, extent and site of hemorrhage, neurosurgical intervention, and neurodevelopmental outcomes, were recorded.ResultsSeventeen of the 53 term infants had infratentorial ICH, 20 had supratentorial ICH, and 16 had a combination of the two. Seizures were the most common presenting symptom (71.7%), another ten infants (18.9%) presented with apneic seizures, and five infants had no clinical signs but were admitted to our NICU because of perinatal asphyxia (n = 2), respiratory distress (n = 2), and development of posthemorrhagic ventricular dilatation (n = 1). Continuous amplitude-integrated electroencephalography recordings were performed in all infants. Clinical or subclinical seizures were seen in 48/53 (90.6%) infants; all received anti-epileptic drugs. Thirteen of all 53 (24.5%) infants died. The lowest mortality rate was seen in infants with supratentorial ICH (10%). Three infants with a midline shift required craniotomy, six infants needed a subcutaneous reservoir due to outflow obstruction, and three subsequently required a ventriculoperitoneal shunt. The group with poor outcome (death or developmental quotient (DQ) <85) had a significantly lower 5-min Apgar score (p = .006). Follow-up data were available for 37/40 survivors aged at least 15 months. Patients were assessed with the Griffiths Mental Developmental Scales, and the mean DQ of all survivors was 97 (SD = 12). Six infants (17%) had a DQ below 85 [two of them had cerebral palsy (CP)]. Three infants developed CP (8.6%); one had cerebellar ataxia, and two had hemiplegia.ConclusionICH with parenchymal involvement carries a risk of adverse neurological sequelae with a mortality of 24.5% and development of CP in 8.6%. The high mortality rate could partly be explained by associated perinatal asphyxia. Infants with supratentorial ICH had a lower, although not significant, mortality rate compared with infants with infratentorial ICH and infants with a combination of supratentorial ICH and infratentorial ICH. In spite of often large intraparenchymal lesions, 30 of the 34 survivors without CP (88.2%) had normal neurodevelopmental outcome at 15 months.

Life After Perinatal Stroke

“…61 Another single center cohort study suggested similar outcomes in 53 term neonates with parenchymal hemorrhage and mortality of 25% but developmental delays in <20% and cerebral palsy in <10%. 62 Typical of all perinatal brain injury outcome studies is the limitation imposed by relatively shorter term follow-ups with most children not reaching school-age where higher order deficits manifest. NHS recurrence risk seems to be low, perhaps suggesting that one-time pathogeneses such as small vascular malformations that rupture and obliterate during transition to extrauterine life account for a significant proportion of otherwise unexplained cases.…”

Neurological Outcome in a Term Infant with Tentorial Laceration Leading to Subdural Haemorrhage Following Vacuum-Assisted Delivery: A Case Report and Literature Review

“…Although signifi cant bleeds in the posterior fossa can be picked up by CUS, as noted in our case, being and operator-dependent procedure, it has been deemed rather insensitive, particularly for retrocerebellar bleeds unless large enough to cause cerebellar displacement [13]. CT scan is therefore advised for confi rmation [14] and thus the initial management would depend on clinical judgment until then. Blauwblomme et al.…”

“…Risk factors for developing SDH in general are outlined in Table 1 [12]. Clues in the neonate can be highly variable and include any number or combination of the following; bulging fontanellae, increased occipito-frontal circumference, apnoea, bradycardia, respiratory distress, retinal haemorrhage, lethargy, fever, opisthotonus and seizures [14,15]. Volpe inferred in an article that slow-reacting or unreactive pupils due to compression of the occulomotor nerve are the most distinctive sign of posterior fossa [12].…”

Spectrum of magnetic resonance imaging abnormalities in neonatal seizures in a tertiary care hospital in India

“…IVH was observed in 3% of infants presenting with neonatal seizures and may be an incidental finding. 23,24 The common cause for transient metabolic disorder with MRI abnormality was hypoglycemia (88%). The typical pattern involving the occipital region and splenium of corpus callosum has been the characteristic MRI change consistently observed in infants with hypoglycemic encephalopathy.…”