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A Follow-up Study of Infants with Intracranial Hemorrhage at Full-Term

  • Balraj S. Jhawar (a1), Adrianna Ranger (a1), David A. Steven (a1) and Rolando F. Del Maestro (a2)

Abstract:

Objective:

To determine physical and cognitive outcomes of full-term infants who suffered intracranial hemorrhage (ICH) at birth.

Methods:

A retrospective hospital-based, follow-up study of infants treated in London, Ontario between 1985 and 1996. Follow-up was conducted by telephone interviews and clinic visits. Outcome was measured according to physical and cognitive scales. Perinatal risk factors and hemorrhage characteristics were correlated with final outcome.

Results:

For this study 66 infants with ICH were identified, of which seven died during the first week of life. We obtained follow-up in all but ten cases (median = 3-years; range 1.0 to 10.9 years). Overall, 57% of infants had no physical or cognitive deficits at follow-up. Death occurred most frequently among those with primarily subarachnoid hemorrhage (19%) and the most favorable outcomes occurred among those with subdural hemorrhage (80% had no disability). In univariate models, thrombocytopenia (platelet count ≤ 70 x 109/L), increasing overall hemorrhage severity, frontal location and spontaneous vaginal delivery as opposed to forceps-assisted delivery increased risk for poor outcome. In multivariate models, all these factors tended towards increased risk, but only thrombocytopenia remained significant for physical disability (OR = 7.6; 95% CI = 1.02 – 56.6); thrombocytopenia was borderline significant in similar models for cognitive disability (OR = 4.6; 95% CI = 0.9 – 23.9).

Conclusion:

Although forceps-assisted delivery may contribute to ICH occurrence, our study found better outcomes among these infants than those who had ICH following a spontaneous vaginal delivery. Hemorrhage in the frontal lobe was the most disabling hemorrhage location and if multiple compartments were involved, disability was also more likely to occur. However, in this report we found that the factor that was most likely to contribute to poor outcome was thrombocytopenia and this remained important in multivariate analysis.

RÉSUMÉ: Objectif:

Déterminer l’issue physique et cognitive chez des nourrissons nés à terme qui ont subi une hémorragie intracrânienne (HIC) à la naissance.

Méthodes:

Il s’agit d’une étude rétrospective de suivi hospitalier de nourrissons traités à London, Ontario, entre 1985 et 1996. Le suivi a été fait au moyen d’entrevues téléphoniques et de visites à la clinique. L’issue était évaluée au moyen d’échelles physiques et cognitives. Les facteurs de risque périnataux et les caractéristiques de l’hémorragie ont été corrélés à l’issue finale.

Résultats:

Soixante-six nourrissons ayant subi une HIC ont été identifiés, dont sept sont morts dans la première semaine de vie. Nous avons obtenu des informations sur cinquante-six enfants (âge médian de 3 ans; écart de 1,0 à 10,9 ans). Au moment du suivi, 57% des enfants n’avaient pas de déficit physique ou cognitif. 19% des enfants ayant subi une hémorragie sous-arachnoïdienne sont morts. L’issue la plus favorable a été observée chez ceux qui avaient subi une hémorragie sous-durale (80% n’avaient pas de déficit). À l’analyse univariée, la thrombocytopénie (décompte plaquettaire 70 x 109/L), la sévérité de l’hémorragie, la localisation frontale et un accouchement vaginal spontané plutôt qu’avec forceps augmentaient le risque d’une issue défavorable. À l’analyse multivariée, tous ces facteurs indiquaient un risque accru, mais seulement la thrombocytopénie demeurait un facteur significatif de l’invalidité physique (rapport de cotes 7,6 ; IC à 95% de 1,2 à 56,6) et était limite pour le déficit cognitif (rapport de cotes 4,6; IC à 95% de 0,9 à 23,9).

Conclusion:

Bien que l’accouchement avec forceps puisse contribuer à l’HIC, l’issue était meilleure chez ces nourrissons que chez ceux qui avaient subi une HIC à la suite d’un accouchement vaginal spontané. L’HIC au lobe frontal était la plus invalidante et, si plusieurs compartiments étaient touchés, une invalidité était plus probable. Cependant, dans cette étude, le facteur qui contribuait le plus à une issue défavorable était la thrombocytopénie et ceci demeurait important à l’analyse multivariée.

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Copyright

Corresponding author

Division of Neurosurgery, London Health Sciences Centre, University of Western Ontario, London, ON N6A 5A5 Canada

References

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