title: Subdural hemorrhage and hypoxia in infants with congenital heart disease.
abstract: OBJECTIVE
  It has been suggested that there is a causal relationship between hypoxia and subdural hemorrhage (SDH) in infancy. The purpose of this study was to review the incidence of SDH in infants with congenital heart disease and explore the relationship between SDH and hypoxia.
  
  
  METHODS
  Review of data collected for a prospective longitudinal cohort study of infants undergoing surgery for congenital heart disease in New Zealand and Australia. Infants underwent serial MRI scans of the brain in the first 3 months of life. All oxygen saturation recordings and MRI results were extracted and infants assigned to categories by degree of hypoxia. The data were then examined for any statistically significant relationship between hypoxia and SDH.
  
  
  RESULTS
  One hundred fifty-two infants underwent MRI scans, and 66 (43%) had 145 loci of SDH. New SDH was seen in 12 infants after cardiac surgery. Of the loci of SDH, 63 (43%) were supratentorial, and most of these were interhemispheric, parietal, or temporal. SDH present on the first MRI persisted beyond 28 days of life in 8 infants. There was no demonstrable relationship between SDH and hypoxia.
  
  
  CONCLUSIONS
  Asymptomatic SDH is common in young infants with congenital heart disease, at a frequency similar to that of those without congenital heart disease. These SDHs may occur in locations where they occur in abusive head trauma, but they are typically small and resolve within 3 months of birth. We were unable to demonstrate any association between hypoxia and SDH in this cohort.
authors.affiliation: Te Puaruruhau (Child Protection Team), Department of Pediatrics, Faculty of Medical and Health Sciences, University of Auckland, New Zealand; patrickk@adhb.govt.nz.
authors.forename: Patrick
authors.initials: P
authors.lastname: Kelly
authors.affiliation: Children's Emergency Department.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hayman
authors.affiliation: Section of Critical Care Medicine, Texas Children's Hospital, Houston, Texas;
authors.forename: Lara S
authors.initials: LS
authors.lastname: Shekerdemian
authors.affiliation: Children's Research Centre, and.
authors.forename: Peter
authors.initials: P
authors.lastname: Reed
authors.affiliation: Department of Neuroradiology, Auckland City Hospital, Auckland, New Zealand;
authors.forename: Ayton
authors.initials: A
authors.lastname: Hope
authors.affiliation: Departments of Neonatal Medicine, and Murdoch Children's Research Institute, Melbourne, Australia.
authors.forename: Julia
authors.initials: J
authors.lastname: Gunn
authors.affiliation: Radiology, The Royal Children's Hospital, Melbourne, Australia; and.
authors.forename: Lee
authors.initials: L
authors.lastname: Coleman
authors.affiliation: Pediatric ICU, Starship Children's Hospital, Auckland, New Zealand;
authors.forename: John
authors.initials: J
authors.lastname: Beca
mesh_terms: D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000453:epidemiology*; D006408:Hematoma, Subdural / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis* / Q000453:epidemiology*; D007223:Infant; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D011446:Prospective Studies
keywords: abusive head trauma; hypoxia; neonates; subdural hemorrhage