title: Incidental intracranial hemorrhage after uncomplicated birth: MRI before and after neonatal heart surgery.
abstract: We investigated the prevalence of intracranial hemorrhage (ICH) before and after neonatal heart surgery. We carried out pre- and postoperative MRI looking for brain lesions in 24 full-term newborns with known congenital heart disease. They underwent heart surgery with cardiopulmonary bypass (CPB), usually with deep hypothermic circulatory arrest (DHCA). The first MRI was 1-22 days after birth. There were 21 children born after uncomplicated vaginal delivery and three delivered by cesarean section (CS). ICH was seen in 13 (62%) of the vaginal delivery group but in none of the CS group. We saw subdural bleeding along the inferior surface of the tentorium in 11 (52%) and supratentorially in six (29%) of the 21 children with ICH. Small hemorrhages were present in the choroid plexus in seven (33%), in the parenchyma in one (5%) and in the occipital horn in one (5%). There were 26 foci of bleeding in these 21 patients (1.2 per patient). None was judged by formal neurologic examination to be symptomatic from the hemorrhage. Follow-up MRI after cardiac surgery was obtained in 23 children, showing 37 foci of ICH (1.6 per patient), but all appeared asymptomatic. Postoperatively, ICH had increased in 10 children (43%), was unchanged in seven (30%) and was less extensive in six (26%).
authors.affiliation: Neuroradiology Department, The Children's Hospital of Philadelphia, 34th Street & Civic Center Blvd, Philadelphia, PA 19104, USA.
authors.forename: F
authors.initials: F
authors.lastname: Tavani
authors.forename: R A
authors.initials: RA
authors.lastname: Zimmerman
authors.forename: R R
authors.initials: RR
authors.lastname: Clancy
authors.forename: D J
authors.initials: DJ
authors.lastname: Licht
authors.forename: W T
authors.initials: WT
authors.lastname: Mahle
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D036861:Delivery, Obstetric; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000209:etiology* / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male