Intracranial Hemorrhage in Term or Near-term Newborns With Persistent Pulmonary Hypertension

Abstract

To substantiate the clinical impression of an increased incidence of intracranial hemorrhage (ICH) in term and near-term infants with persistent pulmonary hypertension (PPH), a retrospective chart review of 35 affected patients was performed. ICH was diagnosed in 40 percent of the patients. Multiple regions of the brain were affected; in many patients, at more than one location. In addition, 43 percent of ICH victims had hemorrhages of the type associated with periventricular bleeding in preterm newborns. Of multiple obstetric and neonatal factors analyzed, many of which are identified risk factors for periventricular hemorrhage, only thrombocytopenia (p = 0.02) was significantly associated with ICH. We conclude that the risk of ICH in newborns with PPH is significant and warrants consideration by clinicians caring for this population. Risk factors (except thrombocytopenia) previously implicated in other types of neonatal ICH, particularly periventricular hemorrhage, do not significantly correlate with ICH in infants with PPH.

Get full access to this article

View all access options for this article.

References

Dubowitz Lms , Levene MI , Morante A. , et al. Neurologic signs in neonatal intraventricular hemorrhage: A correlation with real-time ultrasound. J Pediatr 1981;99:127-33.

Fitzhardinge PM , Flodmard O. , Fitz CR , et al. The prognostic value of computed tomography as an adjunct to assessment of the term infant with postasphyxial encephalopathy . J Pediatr 1981;99:777-81.

Donat JF , Okazaki H. , Kleinberg F. , et al. Intraventricular hemorrhage in full-term and premature infants . Mayo Clin Proc 1978;53:437-41.

Levene MI , Wigglesworth JS , Dubowitz V. Cerebral structure and intraventricular hemorrhage in the neonate: A real-time ultrasound study. Arch Dis Child 1981;56:416-24.

Mitchell W. , O'Tuama L. Cerebral intraventricular hemorrhages in infants: A widening age spectrum . Pediatrics 1980;65:35-9.

Miller GM , Black VD , Lubchenco LO Intracerebral hemorrhage in a term newborn with hyperviscocity. Am J Dis Child 1981;135:377-8.

Palma PA , Miner MA , Morriss FH , et al. Intraventricular hemorrhage in the neonate born at term. Am J Dis Child 1979:133:941-44.

Bergman I. , Bauer RE , Barmada MA , et al. Intracerebral hemorrhage in the full-term neonatal infant. Pediatrics 1985;75:488-96.

Flodmark I. , Becker LE , Harwood-Nash DC , et al. Correlation between computed tomography and autopsy in premature and full-term neonates that have suffered perinatal asphyxia. Radiology 1980;137:93-103.

10.

Andreoli S. , Josephson DA , Schreiner RL Late presentation of intraventricular hemorrhage in terms infants without predisposing factors. J Indiana State Med Assoc 1982; 75:460-2.

11.

Baleriaux D. , Ticket L. , Dony D. , et al. The contribution of CT to perinatal intracranial hemorrhage including that accompanying apparently uncomplicated delivery at full term. Neuroradiology 1980 ;19:273-7.

12.

Mackay RJ , Ch. deCrispigny L. , Murton LJ , et al. Intraventricular hemorrhage in term neonates: Diagnosis by ultrasound . Aust Paediatr J 1982;18:205-70.

13.

Scher MS , Wright FS , Lockman LA , et al. Intraventricular hemorrhage in the full-term neonate. Arch Neurol 1982;19:769-72.

14.

Tarby TJ , Volpe JJ Intraventricular hemorrhage in the premature infant. Pediatr Clin North Am 1982;29:1077-104.

15.

Clark CE , Clyman RI , Roth RS , et al. Risk factor analysis of intraventricular hemorrhage in low-birth-weight infants. J Pediatr 1981;99:625-8.

16.

Volpe JJ Neonatal Intraventricular hemorrhage. N Engl J Med 1981;304:886-91.

17.

Van De Bor M. , Van Bel F. , Lineman R. , et al. Perinatal factors and periventricular-intraventricular hemorrhage in preterm infants. Am J Dis Child 1986; 140:1125-30.

18.

McDonald MM , Koops BL , Johnson ML , et al. Timing and antecedents of intracranial hemorrhage in the newborn. Pediatrics 1984 ;74:32-6.

19.

Andrew M. , Castle V. , Saigal S. , et al. Clinical impact of neonatal thrombocytopenia. J Pediatr 1987;110:457-64.

20.

Van De Bor M. , Briet E. , Van Bel F. , et al. Hemostasis and periventricular-intraventricular hemorrhage of the newborn. Am J Dis Child 1986;140:1131-4.

21.

Snedecor GW , Cochran, WG. Statistical Methods. Ames, Iowa: Iowa State University Press, 1976;209-10.

22.

Papile LA , Burstein J. , Burstein R. , et al. Incidence and evolution of subependymal and intraventricular hemorrhage. A study of infants with birth weights less than 1,500 g. J Pediatr 1978;92:529-34.

23.

Volpe JJ Anterior fontanelle: Window to the neonatal brain. J Pediatr 1982;100:395-7.

24.

Bergman I. Questions concerning safety and use of cranial ultrasonography in the neonate . J Pediatr 1983;103:855-8.