title: Nontraumatic intradural and subdural hemorrhage and hypoxic ischemic encephalopathy in fetuses, infants, and children up to three years of age: analysis of two audits of 636 cases from two referral centers in the United Kingdom.
abstract: We analyzed the presence or absence of intradural hemorrhage (IDH) and subdural hemorrhage (SDH) and the degree of hypoxic-ischemic encephalopathy (HIE) in the brain of all nonmacerated fetuses of >24 weeks, neonates, and children up to 3 years of age who died of natural causes over a defined period. We looked into the cause of death and the performance of cardiopulmonary resuscitation in our cohort. The IDH was classified as macroscopic or negative/microscopic only; the HIE was classified as absent, indeterminate, or definite. In fetuses, SDH with IDH was present in 22%; IDH alone was present in 31%, and there was no or minimal hemorrhage in 47% of cases. In infants and children SDH with IDH was present in 19%; IDH alone was present in the 32%, and there was no or minimal hemorrhage in 49% of cases. There was a statistically significant correlation between SDH and HIE, especially in infants and children (P < 0.001). When cases were grouped per age, a significant association between age and hemorrhage (P < 0.0001) was demonstrated, SDH being more common in infants ≤1 month corrected age. Intradural hemorrhage can be the source of thin-film SDH in fetuses, infants, and young children. The presence of SDH is associated with hypoxia. Intradural and subdural hemorrhages are more common in autopsies of infants under 1 month corrected age. Although more rare, they can also be found in children between 1 month and 3 years of age in the absence of trauma.
authors.affiliation: Barts Health NHS Trust, United Kingdom. i.b.sheimberg@qmul.ac.uk
authors.forename: Irene
authors.initials: I
authors.lastname: Scheimberg
authors.forename: Marta C
authors.initials: MC
authors.lastname: Cohen
authors.forename: Rita E
authors.initials: RE
authors.lastname: Zapata Vazquez
authors.forename: Susan
authors.initials: S
authors.lastname: Dilly
authors.forename: Mudher Al
authors.initials: MA
authors.lastname: Adnani
authors.forename: Kerry
authors.initials: K
authors.lastname: Turner
authors.forename: Chitra
authors.initials: C
authors.lastname: Sethuraman
mesh_terms: D001344:Autopsy; D002543:Cerebral Hemorrhage / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D002675:Child, Preschool; D005260:Female; D005333:Fetus; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000150:complications / Q000453:epidemiology* / Q000473:pathology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D006113:United Kingdom / Q000453:epidemiology