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Acute intracranial hematomas in term neonates.
Summary
Acute intracranial hematomas in neonates often result from multiple factors including birth trauma and oxygen deprivation. Early diagnosis via imaging and prompt surgical evacuation, particularly for midline shift, improves outcomes, though severe perinatal anoxia indicates a poor prognosis.
Area of Science:
- Neonatal Neurology
- Pediatric Neurosurgery
- Medical Imaging in Neonates
Background:
- Acute intracranial hematomas present a significant challenge in term neonates.
- These hematomas can be subdural, intracerebral, or intraventricular, often occurring supratentorially.
Purpose of the Study:
- To report on a series of acute intracranial hematomas in term neonates.
- To analyze the causes, diagnostic methods, treatment outcomes, and prognostic factors.
Main Methods:
- Retrospective review of 17 term neonates with acute intracranial hematomas.
- Surgical evacuation (aspiration or craniotomy) or conservative management based on hematoma characteristics.
- Comparison with 110 previously published cases.
Main Results:
- Hematomas were subdural (posterior fossa or supratentorial), intracerebral, or intraventricular.
- Surgical evacuation was performed in 10 cases, aspiration in 3, and 4 were managed conservatively.
- Mortality occurred in 3 patients; 14 survivors had major (3) or minor/no (11) neurological sequelae.
- Hydrocephalus requiring treatment occurred in 2 survivors.
Conclusions:
- Multifactorial causes include obstetrical trauma, anoxia, and coagulation disorders.
- Early diagnosis necessitates prompt echography and/or CT scans.
- Early evacuation is advocated for hematomas causing midline shift.
- Prognosis is poor with severe perinatal anoxia; otherwise, it appears favorable but requires longer follow-up.