Subcapsular hemorrhage of the liver in a neonate with extremely low birthweight

Subcapsular hemorrhage of the liver (SHL) is usually an autopsy finding rather than a clinical diagnosis. Recent literature has noted an increased incidence of SHL in premature infants. A 26-week, 899 g female was born via emergency cesarean section due to excessive vaginal bleeding. At birth and during the first few days of life, the infant presented with anemia which was masked by concomitant maternal antepartum hemorrhage and neonatal intraventricular hemorrhage. SHL was suspected when the infant developed marked anemia, abdominal distension and hemoperitoneum on day 11 of life. Despite supportive transfusions, the infant's condition deteriorated and she died at 15 days of age. A large subcapsular hematoma of the liver was found at autopsy. We thus conclude that SHL should be considered in the normal course of differential diagnosis of acute blood loss in premature neonates.