Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, Maryland; Neurosciences Intensive Care Nursery, Johns Hopkins School of Medicine, Baltimore, Maryland.
Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, Maryland; Neurosciences Intensive Care Nursery, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Neurology, University of Michigan School of Medicine, Ann Arbor, Michigan.
Pediatr Neurol. 2021 Jul;120:52-58. doi: 10.1016/j.pediatrneurol.2021.04.011. Epub 2021 Apr 28.
Subpial hemorrhages are underrecognized, underreported, and poorly understood. The spectrum of their clinical manifestations and consequences in neonates has not been fully described. Here, we describe the demographic, clinical, and radiographic characteristics of neonates with subpial hemorrhages.
We reviewed the medical records and neuroimaging studies of neonates with subpial hemorrhage who were admitted to our neonatal intensive care unit between September 2009 and December 2020.
Of 114 neonates with intracranial hemorrhage, 31 (27%) had subpial hemorrhage. The majority of neonates in our cohort were male (68%) and born at term (55%). The most common imaging indication was apneas and/or seizures in 58%. Common comorbid conditions included cardiorespiratory failure (42%), hypoxic-ischemic encephalopathy (26%), and coagulopathy (23%). Subpial hemorrhages were multifocal in 45% of neonates, located in the temporal lobe in 45% of neonates, and tended to be larger in neonates with coagulopathy, birth trauma, or hydrocephalus requiring neurosurgical intervention. Subpial hemorrhage was associated with another type of intracranial bleed in 77% of cases and with arterial ischemic stroke in 16% of cases. Of 17 patients with more than one year of follow-up data, 14 (82%) have developmental delay and four (24%) have epilepsy. Of 14 patients with follow-up imaging, 10 (71%) had encephalomalacia subjacent to the subpial hemorrhage.
This is the largest cohort of neonates with subpial hemorrhages to date. Outcome data are limited by duration of follow-up and may be confounded by comorbid conditions and other concurrent hemorrhages. Further study is needed to define the spectrum of risk factors and expected neurological outcomes.
皮质下出血未被充分认识、报告和理解。其在新生儿中的临床表现和后果尚未完全描述。在此，我们描述了皮质下出血新生儿的人口统计学、临床和影像学特征。
我们回顾了 2009 年 9 月至 2020 年 12 月期间在我们新生儿重症监护病房住院的皮质下出血新生儿的病历和神经影像学研究。
在 114 例颅内出血的新生儿中，31 例（27%）有皮质下出血。我们队列中的大多数新生儿为男性（68%）和足月出生（55%）。最常见的影像学指征是呼吸暂停和/或癫痫发作（58%）。常见合并症包括心肺衰竭（42%）、缺氧缺血性脑病（26%）和凝血障碍（23%）。皮质下出血在 45%的新生儿中为多灶性，在 45%的新生儿中位于颞叶，在凝血障碍、产伤或需要神经外科干预的脑积水的新生儿中往往更大。皮质下出血在 77%的病例中与另一种类型的颅内出血有关，在 16%的病例中与动脉缺血性中风有关。在 17 名有超过一年随访数据的患者中，14 名（82%）有发育迟缓，4 名（24%）有癫痫。在 14 名有随访影像学资料的患者中，10 名（71%）皮质下出血下有脑软化。
这是迄今为止最大的皮质下出血新生儿队列。由于随访时间的限制，结果数据可能受到合并症和其他同时发生的出血的影响。需要进一步研究以确定风险因素和预期的神经结局的范围。
Zotero 插件