Symptomatic subarachnoid hemorrhage in the term newborn

A review of the medical records of 35 term newborn infants with confirmed subarachnoid hemorrhage was undertaken to examine etiologic, clinical, laboratory, and neurodevelopmental aspects of this lesion. The most common clinical presentation was convulsive activity (69%), followed by apnea (23%), and bradycardia. Thirty-one of these infants (89%) survived, but only 16 (52%) were felt to be neurologically normal at latest evaluation. Outcomes appeared to be similar regardless of whether the presumed etiology was hypoxic-ischemic or traumatic. Six surviving infants (19%) developed post-hemorrhagic hydrocephalus, but in three of these there was a delayed presentation well beyond the neonatal period. Symptomatic subarachnoid hemorrhage in the term newborn may be a more serious event than previously believed. Close neurodevelopmental follow-up and surveillance for hydrocephalus is warranted.