Elsevier

Pediatric Neurology

Volume 26, Issue 4, April 2002, Pages 301-304
Pediatric Neurology

Original article
Subdural hematoma in term infants

https://doi.org/10.1016/S0887-8994(01)00420-9Get rights and content

Abstract

Subdural hematomas are uncommon in term infants. The study objectives were to evaluate risk factors for and clinical significance of small subdural hematomas observed on computerized tomography. During a 3-year period, 26 near-term and term nonasphyxiated infants were found to have a subdural hematoma on computed tomography. Clinical indications for computed tomography were respiratory symptoms in 15 infants and neurologic symptoms in 10 infants; one infant had a skull fracture. Subdural hematomas were less than 3-mm maximum transverse dimensions in all infants: location was infratentorial (n = 7), supratentorial (n = 7), and in both sites (n = 12). Four infants also had evidence of edema and hemorrhage within the anterior temporal lobe. Delivery was vaginal in 25 of 26 infants, and forceps were used in 13 (50%) infants. Twenty-five infants were managed expectantly; one infant underwent surgical elevation of a depressed skull fracture. No infant required surgical evacuation of the subdural hematoma. At discharge, nine infants with subdural hematoma exhibited an abnormal examination, i.e., mild hypotonia (n = 7) and Erb’s palsy (n = 2). The clinical syndrome attributed to subdural hematoma was most often a subtle clinical problem. The presence of subdural hematoma documented by computed tomography is not necessarily always indicative of birth trauma and may occur as sequelae of an otherwise uncomplicated delivery.

Introduction

Subdural hematoma is a known complication of birth trauma and is most readily diagnosed using nonenhanced cranial computed tomography. Subdural hematomas may vary from large with significant mass effect to small and clinically insignificant, being detectable only by computerized tomography [1], [2], [3], [4], [5], [6]. However, nontraumatic etiologies of subdural hematoma have been reported, and prenatal subdural hematoma has been described [3], [17]. Moreover, in recent years in our institution the diagnosis of subdural hematoma has been made by computed tomography scan usually as an incidental finding. These latter observations may have important clinical implications and prompted this retrospective review. The objective was to evaluate risk factors for and the clinical significance of small subdural hematoma observed on computed tomography in near-term and term neonates.

Section snippets

Methods

The study patients consisted of near-term and term nonasphyxiated infants admitted to the neonatal intensive care unit at Parkland Memorial Hospital, Dallas, Texas, between January 1995 and December 1998 who underwent cranial computed tomography and in whom the diagnosis of subdural hematoma was made. During the study period, approximately 50,000 near-term and term nonasphyxiated infants were delivered at our institution. Computed tomography was performed without contrast using 3-5 mm axial

General

Subdural hematomas were found in 26 infants. The birth weight was 3,030 ± 619 gm, and gestation was 37.7 ± 2.8 weeks; four infants were at the 35 weeks gestation level, and two were small for gestation. The clinical manifestations that prompted computed tomography were respiratory symptoms in 15 infants (i.e., unexplained apnea) (n = 8), dusky episodes (n = 7), and neurologic symptoms in 10 infants (i.e., subtle seizures) (n = 5), hypotonia or decreased movement of extremities (n = 3), lethargy

Discussion

Subdural hemorrhage is described as an infrequent but potentially serious clinical problem in the infant period. Significant hemorrhage may result from tears in the falx and tentorium or bridging cortical veins secondary to stretching, which is most likely to occur during labor under circumstances when anterioposterior compression of the head is associated with excessive vertical molding and frontal-occipital elongation of the cranium [1]. Thus subdural hematoma has long been considered to be a

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