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Clinical Manifestations of Symptomatic Intracranial Hemorrhage in Term Neonates: 18 Years of Experience in a Medical Center

  • Mei-Chen Ou-Yang
    Affiliations
    Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chiayi, Taiwan

    Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung, Taiwan

    Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Chung-Bin Huang
    Affiliations
    Department of Pediatrics, Kuang Tien General Hospital, Taichung, Taiwan

    Department of Nursing, Hung Kuang University, Taichung, Taiwan
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  • Hsin-Chun Huang
    Affiliations
    Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung, Taiwan

    Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Mei-Yung Chung
    Affiliations
    Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung, Taiwan

    Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Chih-Cheng Chen
    Affiliations
    Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung, Taiwan

    Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Feng-Shun Chen
    Affiliations
    Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung, Taiwan

    Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Pei-Hsin Chao
    Affiliations
    Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung, Taiwan

    Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • I-Lun Chen
    Affiliations
    Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung, Taiwan

    Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Mei-Hui Ou-Yang
    Affiliations
    San An Hospital, Kaohsiung, Taiwan
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  • Chieh-An Liu
    Correspondence
    Corresponding author. Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital at Kaohsiung, 123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan
    Affiliations
    Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung, Taiwan

    Chang Gung University College of Medicine, Kaohsiung, Taiwan
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      Background

      Intracranial hemorrhage (ICH) is an uncommon but important cause of morbidity and mortality in term neonates. We conducted a retrospective analysis of the clinical characteristics and developmental outcomes of symptomatic ICH in term neonates.

      Methods

      A retrospective chart review was conducted of all term neonates (less than 1 month old) diagnosed with ICH and admitted to the neonatal intensive care unit of Kaohsiung Chang Gung Hospital from December 1991 to December 2008. Demographic characteristics, mode of delivery, laboratory data, clinical presentation, and developmental status were recorded.

      Results

      Data for 24 term neonates (17 boys and 7 girls) with a diagnosis of ICH were collected for analysis. The clinical manifestations of ICH included anemia (13/24, 54%), seizure (11/24, 46%), cyanosis (7/24, 29%), tachypnea (5/24, 21%), fever (1/24, 4%), hypothermia (1/24, 4%), and poor feeding (1/24, 4%). Age at symptom onset ranged from 2 hours to 11 days following birth. The most common type of ICH was subdural hemorrhage. All ICHs resolved, except in one infant, who died from hypoxicischemic encephalopathy at 25 days. Ten children with symptomatic ICH were reported to have normal development, while the remainder (13/23, 57%) showed developmental delays or disabilities.

      Conclusion

      Unexplained anemia, seizure, and cyanosis were the major presenting signs in infants with symptomatic ICH. A diagnosis of ICH should be considered in term neonates who present with one or more of these signs. Although the mortality in term infants with symptomatic ICH was low, more than half

      Key Words

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