Symptomatic intracranial hemorrhage in full-term infants

Abstract

A retrospective analysis was undertaken in a consecutive series of 33 full-term infants (birth weight > 2500 g and a minimum of 37 weeks gestational age) with symptomatic intracranial hemorrhage (ICH) admitted to a regional neonatal intensive care unit from January 1986 to December 1992. Eleven infants were born in our institution; 17 were male. The estimated local incidence of symptomatic ICH for the inborn population was 4.9/10000 live births, with a regional incidence of 2.7/10000 live births. Twenty-four (72.3%) infants presented with seizures, apnea, or respiratory distress. Five (15.1%) children developed ICH associated with extracorporeal membrane oxygenation, ventriculoperitoneal shunting, and cardiac surgery. There were two deaths (6.1%) associated with a grade IV periventricular hemorrhage (PVH) and cardiac surgery. Nine infants (27.3%) showed PVH, while an additional nine children developed multifocal cortical hemorrhages. Eight infants (24.2%) showed extra-axial ICH, four children (12.1%) sustained lobar hemorrhages, and three children (9.1%) showed ICH associated with prenatal CNS abnormalities. Excluding five children with iatrogenic ICH, coagulopathies occurred in 9 of 28 infants (32.1%) and constituted a major determinant of the development of ICH. Neurosurgical intervention was limited to one infant with massive ICH and one child with hydrocephalus as a late sequela of ICH. Developmental follow-up was complete in 32 children with a mean and median duration of 3.4 years. Full-term infants with ICH associated with risk factors for hypoxic-ischemic injury showed a significantly greater risk of developmental delay compared to infants with uncomplicated ICH.

Prevalence and Evolution of Intracranial Hemorrhage in Asymptomatic Term Infants

“…Although all of these factors or a combination of these factors is plausible for the mechanism, SDH as a product of parturition has now been documented in asymptomatic neonates in multiple studies. [14][15][16][17][18][19][20][21][22][23][26][27][28] Although most of the asymptomatic SDHs seen at MR imaging and US were in neonates delivered vaginally, 18% (4 of 22) of our neonates delivered by cesarean birth also had SDH. Most infants with SDH delivered by cesarean birth (75%) had a trial of labor with oxytocin administration before the cesarean delivery.…”

“…A few published series report the finding of hemorrhages in infants who were symptomatic in the neonatal period. [14][15][16][17][18] Some reports suggest that the risk of SDH and other hemorrhages found on imaging of symptomatic infants varies with the method of delivery. 19 Sonography (US) is standard practice for detecting germinal matrix hemorrhage in the preterm neonate and has also been proved to demonstrate posterior fossa SDH.…”

Surgical Treatment of Spontaneous Intracerebral Hemorrhage in a Full-term Infant With Coagulopathy. Case Report.

“…8) Surgical evacuation was not im portant in the management of the majority of previ ous patients. 9,10,15) However, the majority of a large series of fullterm neonates and infants with in tracerebral hemorrhage were managed surgically. 15) The primary indication for surgical intervention was extensive hemorrhage with radiographic evi dence of mass effect in a symptomatic infant.…”

The Experimental Study of Stress-Related Pathological Changes in Cerebral Venous Blood Flow in Newborn Rats Assessed by Doct

“…2,3 The problem is that unlike preterm ICH, ICH in term newborns has di®erent location, multiple etiology, clinical presentation and neurological outcome. 4,5 The incidence or prevalence of ICH is not known. Only some term infants with ICH present with clinical events, so the true incidence of ICH is di±cult to determine.…”