Timing and Antecedents of Intracranial Hemorrhage in the Newborn

Abstract

Fifty newborn infants of less than 33 weeks' gestation were followed prospectively from birth to evaluate the temporal relationships of various clinical factors to the onset and progression of intracranial hemorrhage (ICH) in an inborn population given maximal support. ICH was diagnosed and followed with bedside ultrasound every eight hours. The incidence of intraventricular hemorrhage was 30% and of any ICH was 40% with onset from less than 2 hours to 8 days of age. Grades 2, 3, and 4 ICH correlated with Apgar scores of less than 5 at five minutes, vaginal delivery, longer labors, and intrapartum hemorrhage. There was a significant correlation between ICH and both blood pressure fluctuations of greater than 100% and rapid colloid infusions. Slow transfusions of packed red cells did not appear to precipitate episodes of ICH. In a setting of optimal care, ICH appears to be more related to prenatal stresses than to specific postnatal complications.

Fetal Periventricular Hemorrhage in von Willebrand's Disease: Short Review and First Case Presentation

“…Most reports indicate that the mode of delivery is of minor importance, 3 but that exposure to labor might be an adverse factor. 4 The knowledge concerning prenataJ factors is still fragmentary.2 Hemostasis has, however, been fairly extensively investigated. Its pathogenetic role seems to be of minor importance.2,5 VON WILLEBRAND'S DISEASE/Mullaart, et al…”

Hemostasis in the Pregnant Woman, the Placenta, the Fetus, and the Newborn Infant

“…ICH usually has onset in the first 72 hours of life and is associated with extreme prematurity (<28 weeks of gestation), low Apgar score, vaginal delivery, long labor, maternal hemorrhage, extreme blood pressure fluctuations, and rapid colloid infusions. 92 Preterm infants with ICH show laboratory evidence of DIC with lower fibrinogen, platelet count, antithrombin, and FVIII and higher values for fibrin monomers which corrected spontaneously in surviving infants. 74 Coagulopathy and ICH are increased in babies born to mothers with premature rupture of membranes and suspected chorioamnionitis and are decreased in babies of preeclamptic mothers.…”