Pediatrics & Neonatology
Volume 49, Issue 3 , Pages 71-76, June 2008

Hyperthermia as an Early Sign of Intracranial Hemorrhage in Full-term Neonates

  • Shiuh-Bin Fang

      Affiliations

    • Department of Pediatrics, Taiwan Adventist Hospital, Taipei, Taiwan
    • Department of Infant and Child Care, National Taipei College of Nursing, Taipei, Taiwan
    • Corresponding Author InformationCorresponding author. Department of Pediatrics, Taiwan Adventist Hospital, 424, Section 2, Pateh Road, Taipei 105, Taiwan
    • ,
  • Ya-Ting Chang

      Affiliations

    • Department of Pediatrics, Taiwan Adventist Hospital, Taipei, Taiwan
    • ,
  • Ying-Hsiang Chuo

      Affiliations

    • Department of Pediatrics, Taiwan Adventist Hospital, Taipei, Taiwan
    • ,
  • Suei-Tsau Tsai

      Affiliations

    • Department of Pediatrics, Taiwan Adventist Hospital, Taipei, Taiwan
    • ,
  • Chao-Lin Tseng

      Affiliations

    • Department of Pediatrics, Taiwan Adventist Hospital, Taipei, Taiwan

Received 9 February 2007; received in revised form 12 March 2008; accepted 25 June 2008.

Background

Intracranial hemorrhage (ICH) in full-term infants is uncommon and is a rare cause of neonatal fever. This study was conducted to estimate the incidences of ICH and fever in a hospital-based population, and to determine if the clinical features of neonatal ICH with and without hyperthermia differ.

Methods

We selected 315 afebrile neonates who received cranial ultrasonography screening from 2003 to 2004 as the control group, and 153 neonates diagnosed with fever from 1998 to 2004 as the study group. During the same period, 28 full-term neonates with birth weights > 2500 g and ICH in the first week of life were enrolled retrospectively. They were divided into hyperthermia (n = 11) and nonhyperthermia (n = 17) groups.

Results

Three babies in the control group and 11 in the study group had ICH; the incidence of ICH in the hyperthermia group was significantly higher (3/315 vs. 11/153; p < 0.001). Compared with the nonhyperthermia group, the hyperthermia group had less cyanosis (2/11 vs. 10/17; p = 0.04), less lymphocyte predominance (33.7 vs. 80%; p = 0.032), higher neutrophil/lymphocyte ratio (1.9 vs. 0.3; p = 0.006), higher erythrocyte/leukocyte ratio (425 vs. 79.5; p = 0.05) in cerebrospinal fluid and an increased incidence of subarachnoid hemorrhage accompanied by intracerebral parenchymal hemorrhage (4/11 vs. 0/17; p = 0.016).

Conclusion

The incidence of ICH was higher in febrile than in afebrile neonates. ICH presenting with hyperthermia might go unrecognized, because its other symptoms are subtle and a neutrophil predominance in the cerebrospinal fluid might result in a misdiagnosis of meningitis. ICH in the interior brain tended to manifest more commonly as hyperthermia than did ICH in the superficial brain. A cranial image examination should be considered in the evaluation of neonatal fever.

Key Words:  full-term neonates , hyperthermia , intracranial hemorrhage

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PII: S1875-9572(08)60016-9

doi:10.1016/S1875-9572(08)60016-9

Pediatrics & Neonatology
Volume 49, Issue 3 , Pages 71-76, June 2008

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