Datta Debajyoti, Chisvin Rikki, Tu Albert
Division of Pediatric Neurosurgery, Children's Hospital of Eastern Ontario (CHEO), Rm 3359, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.
Division of Pediatric Neurology, Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada.
Childs Nerv Syst. 2024 Dec 3;41(1):32. doi: 10.1007/s00381-024-06688-y.
Intracranial hemorrhage in the newborn poses a significant challenge to their well-being and subsequent development. In pre-term neonates, germinal matrix hemorrhage is the most common cause of intracranial hemorrhage with the prevalence varying from 20 to 59%. However, in term neonates, the prevalence and type of intracranial hemorrhage have not been well elucidated. The type of hemorrhage occurring in term neonates differs from those occurring in pre-term neonates. We conducted a systematic review to assess the prevalence, type, and risk factors of intracranial hemorrhage occurring in term neonates.
We conducted a systematic review and meta-analysis by searching the PubMed and Embase databases. Inclusion criteria were studies reporting intracranial hemorrhage in term neonates (37 weeks or more gestational age at the time of birth). Exclusion criteria were as follows: (1) studies which examined only a specific type of hemorrhage, (2) studies which examined only a single risk factor, (3) sample size < 20, (4) not in English language, and (5) full text not accessible/available. The studies which met the eligibility criteria were assessed and evaluated by two authors, and data was extracted using a predesigned template. The risk of bias in the included studies was assessed using the Joanna Briggs Institute bias assessment tool. The meta-analysis for prevalence, type of hemorrhage, and risk factor was conducted using MetaXL extension for Microsoft Excel.
A total of 1226 records were identified in a database search of PubMed and Embase. After screening, 20 studies were included in the final analysis. The overall prevalence of intracranial hemorrhage in term neonates was 9.3% (95% CI, 4.9-14.9%). The prevalence of intracranial hemorrhage in asymptomatic patients was 5.8% (95% CI, 2.5-10.2%) and in symptomatic patients was 29.3% (95% CI, 15.3-44.8%). Sub-group analysis of the modality of detection shows that the prevalence of hemorrhage detection was higher with computed tomography/magnetic resonance imaging (CT/MRI) than with ultrasonography (USG). Extra-axial hemorrhage was the most common type of hemorrhage detected, comprising about 32.4% of the overall. The odds of having an intracranial hemorrhage was significantly higher with an instrumental delivery (OR = 3.75, 95% CI, 1.4-10.02).
The present study shows that the prevalence of intracranial hemorrhage is relatively high in symptomatic and asymptomatic patients with extra-axial hemorrhage being the most common type of hemorrhage. The prevalence of hemorrhage varied according to the type of imaging used for detection and ideal imaging modality for evaluation, and the consequences of intracranial hemorrhage in term infants on development remain to be determined.
新生儿颅内出血对其健康及后续发育构成重大挑战。在早产儿中，生发基质出血是颅内出血最常见的原因，患病率在20%至59%之间。然而，足月儿颅内出血的患病率及类型尚未得到充分阐明。足月儿发生的出血类型与早产儿不同。我们进行了一项系统评价，以评估足月儿颅内出血的患病率、类型及危险因素。
我们通过检索PubMed和Embase数据库进行了系统评价和荟萃分析。纳入标准为报告足月儿（出生时胎龄37周或以上）颅内出血的研究。排除标准如下：（1）仅研究特定类型出血的研究；（2）仅研究单一危险因素的研究；（3）样本量<20；（4）非英文研究；（5）无法获取全文。符合纳入标准的研究由两位作者进行评估和评价，并使用预先设计的模板提取数据。使用乔安娜·布里格斯研究所偏倚评估工具评估纳入研究的偏倚风险。使用Microsoft Excel的MetaXL扩展对患病率、出血类型和危险因素进行荟萃分析。
在PubMed和Embase数据库检索中，共识别出1226条记录。筛选后，20项研究纳入最终分析。足月儿颅内出血的总体患病率为9.3%（95%CI，4.9 - 14.9%）。无症状患者颅内出血的患病率为5.8%（95%CI，2.5 - 10.2%），有症状患者为29.3%（95%CI，15.3 - 44.8%）。检测方式的亚组分析显示，计算机断层扫描/磁共振成像（CT/MRI）检测出血的患病率高于超声检查（USG）。轴外出血是检测到的最常见出血类型，约占总体的32.4%。器械助产时发生颅内出血的几率显著更高（OR = 3.75，95%CI，1.4 - 10.02）。
本研究表明，有症状和无症状患者中颅内出血的患病率相对较高，轴外出血是最常见的出血类型。出血患病率因用于检测的成像类型和评估的理想成像方式而异，足月儿颅内出血对发育的影响仍有待确定。
