Birth-Related Subdural Haemorrhage in Asymptomatic Moderate-to-Late Preterm Neonates: Magnetic Resonance Imaging...

Area of Science:

• Neonatal neurology
• Pediatric radiology
• Perinatal medicine

Background:

• Birth-related subdural haemorrhages (SDH) are common in neonates, but their natural history in moderate-to-late preterm (MLP) infants is not well understood.
• SDH in neonates is sometimes misattributed to abusive head trauma, highlighting the need to understand its benign causes and typical resolution patterns.

Purpose of the Study:

• To determine the prevalence, distribution, risk factors, and temporal evolution of birth-related SDH in asymptomatic MLP neonates.
• To compare the characteristics of SDH in MLP neonates with those reported in term neonates.

Main Methods:

• A cohort of asymptomatic neonates born between 32 and 36 weeks of gestation underwent brain MRI scans shortly after birth and at term-equivalent age.
• Subdural haemorrhages were assessed using the Four Quadrant Subdural (FQS) scoring system, and demographic and clinical factors were analyzed.

Main Results:

• Subdural haemorrhages were identified in 25.4% of MLP neonates at the initial scan, predominantly in the posterior cranial fossa and posterior supratentorial regions.
• Higher birth weight and vaginal birth were associated with an increased likelihood of SDH.
• By term-equivalent age, 75% of SDH had resolved, with a significant decrease in the mean FQS score for the remaining cases.

Conclusions:

• Subdural haemorrhage is a frequent finding in asymptomatic MLP neonates, with a similar distribution to that observed in term neonates.
• The identified risk factors for SDH in MLP neonates are higher birth weight and vaginal birth.
• The high rate of resolution by term-equivalent age suggests birth-related SDH is an unlikely cause of SDH in older infants suspected of abusive head trauma.