Clinical Research Article | Published:

Encephalopathy in neonates with subgaleal hemorrhage is a key predictor of outcome

Pediatric Research (2019) | Download Citation

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Abstract

Background

Subgaleal hemorrhage (SGH) is reported to be associated with severe hemodynamic instability, coagulopathy, and even mortality. The importance of the presence or absence of neonatal encephalopathy in predicting SGH outcomes has not been explored. The aim of this study was to determine the relationship of clinical encephalopathy to short-term outcomes in neonates with SGH.

Methods

Neonates ≥35 weeks gestation, diagnosed radiologically with SGH between 2010 and 2017, were included. Cases were divided into encephalopathic and non-encephalopathic. Demographic, clinical, and outcome data were compared between groups.

Results

Of 54,048 live births, 56 had SGH, of them 13 (23%) had encephalopathy. When compared to the non-encephalopathic neonates, encephalopathic neonates had lower Apgar scores, lower hemoglobin, lower platelet count, longer neonatal intensive care unit stay, two (15%) deaths, and four (31%) required blood transfusion. No non-encephalopathic infant with SGH died or required blood transfusion. Notably, on magnetic resonance imaging (MRI), a majority of subgaleal collections had either no or minimal blood products.

Conclusions

In the absence of encephalopathy, SGH is not associated with adverse short-term outcome. Neurological assessment is likely to identify infants at higher risk for adverse outcome. The absence of MRI signal consistent with blood in subgaleal collection warrants further research.

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Affiliations

  1. Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    • Mohamed El-Dib
    • , Melanie P Parziale
    • , Lise Johnson
    • , Joseph J. Volpe
    •  & Terrie Inder
  2. Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA

    • Carol B. Benson
  3. Departments of Medicine and Radiology, Boston Children’s Hospital, Boston, MA, USA

    • P. Ellen Grant
  4. Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA, USA

    • Julian Robinson
  5. Department of Neurology, Boston Children’s Hospital, Boston, MA, USA

    • Joseph J. Volpe

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Contributions

M.E.-D. had substantial contributions to conception and design, data analysis, and interpretation of data. He also drafted the article and had final approval of the version to be published. M.P. had substantial contributions to conception and design, acquisition of data, analysis, and interpretation of data. She co-drafted the article and had final approval of the version to be published. L.J. had substantial contributions to conception and design, acquisition, and interpretation of data. She contributed to revising it critically for important intellectual content, and had final approval of the version to be published. C.B.B. had substantial contributions to conception and design, acquisition, and interpretation of data. She contributed to revising it critically for important intellectual content, and had final approval of the version to be published. P.E.G. had substantial contributions to conception and design, acquisition, and interpretation of data. She contributed to revising it critically for important intellectual content, and had final approval of the version to be published. J.R. had substantial contributions to conception and interpretation of data. He contributed to revising it critically for important intellectual content, and had final approval of the version to be published. J.J.V. had substantial contributions to conception and interpretation of data. He contributed to revising it critically for important intellectual content, and had final approval of the version to be published. T.I. had substantial contributions to conception and interpretation of data. She contributed to revising it critically for important intellectual content, and had final approval of the version to be published.

Competing interests

The authors declare no competing interests.

Corresponding author

Correspondence to Mohamed El-Dib.

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DOI

https://doi.org/10.1038/s41390-019-0400-1