Hepatic subcapsular hematomas in fetuses and neonatal infants

In fetuses and neonates hepatic subcapsular hematomas are relatively common lesions and may be life-threatening. Conditions previously associated with these hematomas include trauma, coagulopathies, hypoxia, sepsis, pneumotho rax, maternal diseases, and placental lesions. In this study of 755 perinat al autopsies, hepatic subcapsular hematomas were found in 52 (6.9%) cases, including 31 stillborn fetuses and 21 liveborn infants. The average body we ight was 690 g. A comparison group consisted of 52 temporally proximal auto psies of fetuses and neonates without hematomas. Body weights, gender, mate rnal age, and stillbirth or postnatal survival were matched as closely as p ossible while evaluating the presence or absence of sepsis, pneumothorax, c erebral germinal matrix hemorrhage, trauma, coagulopathy, placental lesions , and maternal diseases. Sepsis was associated with 62% of the cases with hepatic subcapsular hemato mas and with 25% of the comparison group (P = .0001). Group B streptococcus infection was the most common cause of sepsis, but many different organism s were isolated. Cerebral germinal matrix hemorrhages were present in 35% o f the cases with hematomas and in 14% of the comparison group (P = .0001). No other lesions or conditions were statistically different in the study gr oup versus the comparison group. The delicacy of the hepatic capsule and it s connections to the collagen along the sinusoids provide insight for the p athogenesis of hematomas in premature fetuses and neonates. We conclude tha t sepsis is present in most perinatal cases of hepatic subcapsular hematoma s and that such patients also frequently have cerebral germinal matrix hemo rrhages. Each of these lesions is a greater hazard among very small prematu re fetuses or neonates than among older fetuses and neonates.