title: Subdural haemorrhage and severe coagulopathy resulting in transtentorial uncal herniation in a neonate undergoing therapeutic hypothermia.
abstract: Therapeutic hypothermia has been shown to be efficacious for improving long-term neurodevelopmental outcomes following perinatal asphyxia. Thus, cooling protocols have been adopted at most tertiary neonatal centres. We present a case of a term neonate who underwent therapeutic whole-body cooling for hypoxic ischaemic encephalopathy following a difficult forceps delivery. She abruptly deteriorated, exhibiting signs of transtentorial uncal herniation and severe disseminated intravascular coagulopathy. CT of the head confirmed a life-threatening subdural haematoma and a concealed skull fracture. Hypothermia has been shown to impair haemostasis in vivo and thus may potentially exacerbate occult haemorrhages in a clinical setting. Newborns that require instrument-assisted delivery are a particularly high-risk group for occult head injuries and should undergo careful clinical assessment for fractures and intracranial haemorrhage prior to initiation of therapeutic hypothermia.
authors.affiliation: Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Dianna
authors.initials: D
authors.lastname: Wang
authors.affiliation: Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Hugh
authors.initials: H
authors.lastname: McMillan
authors.affiliation: Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Erika
authors.initials: E
authors.lastname: Bariciak
mesh_terms: D000328:Adult; D001238:Asphyxia Neonatorum / Q000150:complications / Q000628:therapy*; D004211:Disseminated Intravascular Coagulation / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006408:Hematoma, Subdural / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007231:Infant, Newborn; D008588:Meningocele / Q000175:diagnosis / Q000209:etiology*; D011247:Pregnancy; D014057:Tomography, X-Ray Computed
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