Intracranial hemorrhage in term newborn

Abstract

BACKGROUND: The improvements in perinatal care during last decade have changed clinical presentation of intracranial hemorrhage (ICH) among full-term newborns. New imaging techniques allow for diagnosis of ICH even in asymptomatic babies. AIM: Analysis of prevalence and risk factors of ICH among full-term newborns requiring intensive care. MATERIAL AND METHOD: 397 full-term newborns hospitalized in tertiary Neonatal Intensive Care Unit were analyzed. Detailed neurological evaluation, head ultrasound and/or cerebrospinal fluid were done. RESULTS: ICH was diagnosed in 40 newborns. The most common clinical presentation was subarachnoid hemorrhage (n = 24). Multifocal bleeding was more frequent (28/40) than bleeding only to one brain compartment (12/40). In the first week of life bleeding to different compartments was observed, but in the 2nd week of life there was no bleeding to posterior fossa. Eleven newborns died due to ICH (parenchymal and subarachnoid ICH). Significant, independent ICH risk factors were: delivery complications (OR: 10.4: 95% CI: 3.7-29.6), scull bone fractures (OR: 44.4: 95% CI: 4-495), nuchal cord (OR: 6.4: 95% CI: 2.2-18.8), hemorrhagic diathesis (OR: 4.5: 95% CI: 1.2-17.5). CONCLUSIONS: Significant risk factors of ICH among full-term newborns requiring intensive care are: mechanical (scull bone fractures, labor complications) trauma, nuchal cord, hemorrhagic diathesis. In such cases the detailed neurological evaluation and imaging techniques should be used to exclude bleeding. Multifocal bleeding is the most common form of ICH. Because subarachnoid and subdural space are not easy visible by head ultrasound, the CT or MRI scans are recommended in babies with ICH.