Original articleSubdural hematoma in term infants
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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