Clinical manifestations of symptomatic intracranial hemorrhage in term neonates: 18 years of experience in a medical center.
BACKGROUND
Intracranial hemorrhage (ICH) is an uncommon but important cause of morbidity and mortality in term neonates. We conducted a retrospective analysis of the clinical characteristics and developmental outcomes of symptomatic ICH in term neonates.


METHODS
A retrospective chart review was conducted of all term neonates (less than 1 month old) diagnosed with ICH and admitted to the neonatal intensive care unit of Kaohsiung Chang Gung Hospital from December 1991 to December 2008. Demographic characteristics, mode of delivery, laboratory data, clinical presentation, and developmental status were recorded.


RESULTS
Data for 24 term neonates (17 boys and 7 girls) with a diagnosis of ICH were collected for analysis. The clinical manifestations of ICH included anemia (13/24, 54%), seizure (11/24, 46%), cyanosis (7/24, 29%), tachypnea (5/24, 21%), fever (1/24, 4%), hypothermia (1/24, 4%), and poor feeding (1/24, 4%). Age at symptom onset ranged from 2 hours to 11 days following birth. The most common type of ICH was subdural hemorrhage. All ICHs resolved, except in one infant, who died from hypoxicischemic encephalopathy at 25 days. Ten children with symptomatic ICH were reported to have normal development, while the remainder (13/23, 57%) showed developmental delays or disabilities.


CONCLUSIONS
Unexplained anemia, seizure, and cyanosis were the major presenting signs in infants with symptomatic ICH. A diagnosis of ICH should be considered in term neonates who present with one or more of these signs. Although the mortality in term infants with symptomatic ICH was low, more than half.
Ou-Yang
Mei-Chen
MC
Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chiayi, Taiwan; Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Huang
Chung-Bin
CB
Department of Pediatrics, Kuang Tien General Hospital, Taichung, Taiwan; Department of Nursing, Hung Kuang University, Taichung, Taiwan.
Huang
Hsin-Chun
HC
Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Chung
Mei-Yung
MY
Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Chen
Chih-Cheng
CC
Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Chen
Feng-Shun
FS
Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Chao
Pei-Hsin
PH
Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Chen
I-Lun
IL
Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Ou-Yang
Mei-Hui
MH
San An Hospital, Kaohsiung, Taiwan.
Liu
Chieh-An
CA
Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan. Electronic address: liuca@adm.cgmh.org.tw.
D000367:Age Factors; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D005865:Gestational Age; D006760:Hospitalization; D006801:Humans; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome