Fang Shiuh-Bin, Chang Ya-Ting, Chuo Ying-Hsiang, Tsai Suei-Tsau, Tseng Chao-Lin
Department of Pediatrics, Taiwan Adventist Hospital, Taipei, Taiwan.
Pediatr Neonatol. 2008 Jun;49(3):71-6. doi: 10.1016/S1875-9572(08)60016-9.
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.
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 >2500g and ICH in the first week of life were enrolled retrospectively. They were divided into hyperthermia (n=11) and nonhyperthermia (n=17) groups.
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).
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.
足月儿颅内出血（ICH）并不常见，是新生儿发热的罕见原因。本研究旨在评估以医院为基础的人群中ICH和发热的发生率，并确定伴有和不伴有高热的新生儿ICH的临床特征是否存在差异。
我们选择了2003年至2004年接受头颅超声筛查的315例无发热新生儿作为对照组，以及1998年至2004年诊断为发热的153例新生儿作为研究组。同期，回顾性纳入28例出生体重>2500g且在出生后第一周发生ICH的足月儿。他们被分为高热组（n=11）和非高热组（n=17）。
对照组中有3例婴儿发生ICH，研究组中有11例；高热组中ICH的发生率显著更高（3/315对11/153；p<0.001）。与非高热组相比，高热组的发绀较少（2/11对10/17；p=0.04），淋巴细胞优势不明显（33.7%对80%；p=0.032），脑脊液中中性粒细胞/淋巴细胞比值更高（1.9对0.3；p=0.006），红细胞/白细胞比值更高（425对79.5；p=0.05），蛛网膜下腔出血伴脑实质内出血的发生率增加（4/11对0/17；p=0.016）。
发热新生儿中ICH的发生率高于无发热新生儿。伴有高热的ICH可能未被识别，因为其其他症状不明显，且脑脊液中以中性粒细胞为主可能导致误诊为脑膜炎。脑内的ICH比脑浅表的ICH更易表现为高热。在评估新生儿发热时应考虑进行头颅影像学检查。
