Document Detail

Intracranial hemorrhage in full-term newborns: a hospital-based cohort study.
MedLine Citation:
PMID:  20393697     Owner:  NLM     Status:  MEDLINE    
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.
Annemieke J Brouwer; Floris Groenendaal; Corine Koopman; Rutger-Jan A Nievelstein; Sen K Han; Linda S de Vries
Related Documents :
2663307 - Intraventricular hemorrhage and brain injury in the premature infant. neuropathology an...
9544897 - Relationship of uric acid concentrations and severe intraventricular hemorrhage/leukoma...
9099777 - Maternal receipt of magnesium sulfate does not seem to reduce the risk of neonatal whit...
9205447 - Intrapartum, atraumatic, non-asphyxial intracranial hemorrhage in a full-term infant.
8827897 - Effects of oral and intramuscular vitamin k prophylaxis on pivka-ii assay parameters in...
90007 - Group-specific component (gc) 'subtypes' of gc1 by isoelectric focusing in us blacks an...
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neuroradiology     Volume:  52     ISSN:  1432-1920     ISO Abbreviation:  Neuroradiology     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-21     Completed Date:  2010-09-24     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  1302751     Medline TA:  Neuroradiology     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  567-76     Citation Subset:  IM    
Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Cohort Studies
Hospitalization / statistics & numerical data
Infant, Newborn
Intracranial Hemorrhages / diagnosis*,  mortality*
Magnetic Resonance Imaging / statistics & numerical data*
Netherlands / epidemiology
Risk Assessment
Risk Factors
Survival Analysis
Survival Rate
Tomography, X-Ray Computed / statistics & numerical data*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Effect of glycyrrhizin on the activity of CYP3A enzyme in humans.
Next Document:  Novel biosynthesis of (R)-ethyl-3-hydroxyglutarate with (R)-enantioselective hydrolysis of racemic e...