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Cerebellar hemorrhage (CBH) is a reported complication of a traumatic birth(difficult breech delivery or instrumentation), coagulopathy, or as an extension of a severe supratentorial hemorrhage in newborn infants. Previous studies have identified cases from infants presenting with sudden shock and brainstem compression symptomatology or autopsy reports, with CBH complicating 15-25% of autopsy specimens from infants less than 1500 grams. CBH has been difficult to visualize by traditional ultrasonographic approach through the anterior fontanel, although recent advances in transducer head size have allowed better visualization through less utilized fontanels. Late in 1994, standard cerebellar imaging through the posterolateral fontanel was instituted using a 5-7.5 MHz high frequency sector transducer. Approximately 170 infants less than 1500 grams were scanned over the ensuing 12 months and three infants were identified with a CBH. All were delivered by C-section without instrumentation but with evidence of some perinatal asphyxia (n=3) and mild thrombocytopenia (n=2). Each hemorrhage had a clinically silent presentation, was not well appreciated by anterior fontanellar images, and was not associated with a supratentorial intracranial hemorrhage. Two infants had a focal echodensity and one infant had bilateral diffuse echodensities in the peripheral parenchyma of the cerebellum that presented during the first week of life and persisted on ultrasound for 3 to 5 weeks. MRI scans were performed on two infants and documented cerebellar destruction in the area of previous echodensity on ultrasound. All infants survived to discharge however neurodevelopmental followup is thus far limited to less than one year. CBH is an under recognized and poorly visualized complication in preterm infants. Consistent imaging via the posterolateral fontanel may demonstrate CBH frequently missed by the anterior fontanellar approach. Longer term neurodevelopmental followup is necessary to establish the ultimate outcome of these infants.

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(Spon. by Augusto Sola).

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Merrill, J., Fell, S., Goldstein, R. et al. A NEW PATTERN OF CEREBELLAR HEMORRHAGES IN PRETERM INFANTS.1366. Pediatr Res 39, 230 (1996).

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