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AJNR - American Journal of Neuroradiology

Published ahead of print on April 3, 2008
doi: 10.3174/ajnr.A1004

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American Journal of Neuroradiology 29:1082-1089, June-July 2008
© 2008 American Society of Neuroradiology

PEDIATRICS

Prevalence and Evolution of Intracranial Hemorrhage in Asymptomatic Term Infants

V.J. Rooks^a,c, J.P. Eaton^a,e, L. Ruess^a,c,d, G.W. Petermann^a,c, J. Keck-Wherley^b and R.C. Pedersen^b,d

^a Department of Radiology, Tripler Army Medical Center Honolulu, Hawaii
^b Department of Pediatrics, Tripler Army Medical Center Honolulu, Hawaii
^c Department of Radiology and Radiological Sciences, F. Edward Hebert School of Medicine, Uniform Services University of the Health Sciences, Bethesda, Md
^d Department of Pediatrics, F. Edward Hebert School of Medicine, Uniform Services University of the Health Sciences, Bethesda, Md
^e Weed Army Community Hospital, Fort Irwin, Calif

Please address correspondence to Veronica J. Rooks, MD, Department of Radiology, MCHK-DR, Tripler Army Medical Center, Honolulu, HI 96859-5000; e-mail: veronica.rooks{at}us.army.mil

BACKGROUND AND PURPOSE: Subdural hemorrhage (SDH) is often associated with infants experiencing nonaccidental injury (NAI). A study of the appearance and natural evolution of these birth-related hemorrhages, particularly SDH, is important in the forensic evaluation of NAI. The purpose of this study was to determine the normal incidence, size, distribution, and natural history of SDH in asymptomatic term neonates as detected by sonography (US) and MR imaging within 72 hours of birth.

MATERIALS AND METHODS: Birth history, delivery method, duration of each stage of labor, pharmaceutic augmentation, and complications during delivery as well as postnatal physical examination were recorded. Brain MR imaging and US were performed on 101 asymptomatic term infants at 3–7 days, 2 weeks, 1 month, and 3 months. Clinical follow-up at 24 months was recorded.

RESULTS: Forty-six neonates had SDH by MR imaging within 72 hours of delivery. SDH was seen in both vaginal and cesarean deliveries. All neonates were asymptomatic, with normal findings on physical examination. All 46 had supratentorial SDH seen in the posterior cranium. Twenty (43%) also had infratentorial SDH. US detected 11 of the 20 (55%) infratentorial SDHs and no supratentorial SDH. Most SDHs present at birth were 3 mm and had resolved by 1 month, and all resolved by 3 months on MR imaging. Most children with SDHs had normal findings on developmental examinations at 24 months.

CONCLUSION: SDH in asymptomatic term neonates after delivery is limited in size and location.

This article has been cited by other articles:

				W. D. Lo, J. Lee, J. Rusin, E. Perkins, and E. S. Roach Intracranial Hemorrhage in Children: An Evolving Spectrum Arch Neurol, December 1, 2008; 65(12): 1629 - 1633. [Abstract] [Full Text] [PDF]