Spontaneous intraparenchymal hemorrhage in full-term neonates

OBJECTIVE: Spontaneous intraparenchymal hemorrhage is extremely rare in ful l-term newborns. Reports to date have been limited to descriptions of indiv idual cases, small groups within larger studies of intracranial hemorrhage, and one series of four patients. Structural lesions are rarely identified, and the majority of patients described have been managed without surgical intervention. METHODS: Analysis of a computerized database of pediatric neurosurgical pat ients from January 1960 to February 2000 identified full-term newborns youn ger than 3 months of age with nontraumatic intraparenchymal hemorrhages. Pr enatal histories, labor and delivery histories, clinical presentations, ima ging studies, management, and outcomes were reviewed. RESULTS: Eleven full-term newborns with spontaneous intraparenchymal hemorr hages were identified. The majority had normal prenatal courses. Most prese nted within the first 2 days of life (6 of 11 patients), and the most commo n presenting sign was seizure (7 of 11 patients). No cause was identified i n 6 of 11 patients; the remainder were attributed to coagulopathy (n = 3), ruptured intracranial aneurysm (9 = 1), or hemorrhagic infarction (n = 1). Eight patients underwent surgical hematoma evacuation on the basis of radio graphic evidence of significant mass effect, evidence of signs of elevated intracranial pressure, or both. Three patients did not receive surgical int ervention. There were no subsequent hemorrhages or deaths during a mean fol low-up period of 4.5 years (range, 1-16 yr). Four patients had normal neuro logical outcomes, four had motor deficits (one of whom additionally demonst rated cognitive delay), and three had delayed speech. CONCLUSION: No cause is identified in most newborns with spontaneous intrap arenchymal hemorrhage. Radiographic evidence of mass effect or signs of ele vated intracranial pressure may necessitate surgical hematoma evacuation. O utcome varies widely and may be normal, even in patients with sizeable intr aparenchymal hemorrhages.