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

Brouwer AJ, Groenendaal F, Koopman C, Nievelstein RJ, Han SK, de Vries LS - Neuroradiology (2010)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.

ABSTRACT

Introduction: In 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).

Methods: From 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.

Results: Seventeen 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.

Conclusion: ICH 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.

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CT performed on day 2 (a, b), showing large intraparenchymal hemorrhage and SDH in the right frontal lobe, causing a shift in midline. MRI and IR axial view obtained on day 8 following craniotomy (c) showing resolution of the midline shift and reduction of subdural and intraparenchymal hematoma. A repeat MRI and IR axial view at 3 months (d) shows a small area of cavitation and mild atrophy of the right frontal lobe. Outcome was well within the normal range at 2 years of age
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Fig1: CT performed on day 2 (a, b), showing large intraparenchymal hemorrhage and SDH in the right frontal lobe, causing a shift in midline. MRI and IR axial view obtained on day 8 following craniotomy (c) showing resolution of the midline shift and reduction of subdural and intraparenchymal hematoma. A repeat MRI and IR axial view at 3 months (d) shows a small area of cavitation and mild atrophy of the right frontal lobe. Outcome was well within the normal range at 2 years of age

Mentions: The frontal lobe was predominantly affected in 11 infants; this was associated with a midline shift in 7 infants and required surgical intervention in 3 infants (Fig. 1). Delivery was uncomplicated in 7/11 infants (63.6%). The temporal lobe was primarily involved in ten infants. Both frontal and temporal parenchymal hemorrhages can be associated with cerebral sinovenous thrombosis (CSVT). Only 4/21 infants with frontal or temporal parenchymal hemorrhage, possibly associated with CSVT, were studied with PCA, but none had 3D MRV. A possible CSVT of the superior sagittal sinus was suspected on PCA in one child with a large frontal parenchymal hemorrhage.Fig. 1


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

Brouwer AJ, Groenendaal F, Koopman C, Nievelstein RJ, Han SK, de Vries LS - Neuroradiology (2010)

CT performed on day 2 (a, b), showing large intraparenchymal hemorrhage and SDH in the right frontal lobe, causing a shift in midline. MRI and IR axial view obtained on day 8 following craniotomy (c) showing resolution of the midline shift and reduction of subdural and intraparenchymal hematoma. A repeat MRI and IR axial view at 3 months (d) shows a small area of cavitation and mild atrophy of the right frontal lobe. Outcome was well within the normal range at 2 years of age
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2872016&req=5

Fig1: CT performed on day 2 (a, b), showing large intraparenchymal hemorrhage and SDH in the right frontal lobe, causing a shift in midline. MRI and IR axial view obtained on day 8 following craniotomy (c) showing resolution of the midline shift and reduction of subdural and intraparenchymal hematoma. A repeat MRI and IR axial view at 3 months (d) shows a small area of cavitation and mild atrophy of the right frontal lobe. Outcome was well within the normal range at 2 years of age
Mentions: The frontal lobe was predominantly affected in 11 infants; this was associated with a midline shift in 7 infants and required surgical intervention in 3 infants (Fig. 1). Delivery was uncomplicated in 7/11 infants (63.6%). The temporal lobe was primarily involved in ten infants. Both frontal and temporal parenchymal hemorrhages can be associated with cerebral sinovenous thrombosis (CSVT). Only 4/21 infants with frontal or temporal parenchymal hemorrhage, possibly associated with CSVT, were studied with PCA, but none had 3D MRV. A possible CSVT of the superior sagittal sinus was suspected on PCA in one child with a large frontal parenchymal hemorrhage.Fig. 1

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.

ABSTRACT

Introduction: In 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).

Methods: From 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.

Results: Seventeen 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.

Conclusion: ICH 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.

Show MeSH
Related in: MedlinePlus