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Clinical and neuroimaging patterns of perinatal intracranial haemorrhage in fetuses and term-born neonates: a prospective observational cohort study
  1. Moran Hausman-Kedem1,2,
  2. Stephanie Libzon1,3,
  3. Aviva Fattal Valevski1,2,
  4. Gustavo Malinger2,4,
  5. Nina Krajden Haratz2,4,
  6. Itay Tokatly Latzer1,2,
  7. Amit Blumovich1,2,
  8. Jonathan Roth2,5,
  9. Shlomi Constantini5,6,
  10. Dror Mandel2,7,
  11. Liat Ben-Sira2,8,
  12. Shelly I Shiran2,8
  1. 1 Pediatric Neurology Institute, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  2. 2 Faculty of Medical and Health Sciences, School of Medicine, Tel Aviv University, Tel Aviv, Israel
  3. 3 Department of Physical Therapy, School of Health Professions, Tel Aviv University Faculty of Medicine, Tel Aviv, Israel
  4. 4 Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  5. 5 Pediatric Neurosurgery Department and the Pediatric Brain Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  6. 6 Pediatric Neurology Institute, Dana-Dwek Children’s Hospital, Tel Aviv University, Tel Aviv, Israel
  7. 7 Departments of Neonatology and Pediatrics, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  8. 8 Division of Pediatric Radiology, Department of Radiology, Dana Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
  1. Correspondence to Dr Moran Hausman-Kedem; moranhk{at}gmail.com

Abstract

Objectives To characterise perinatal, clinical and neuroimaging patterns and aetiology of perinatal intracranial haemorrhage (pICH), and to assess potential differences between cases diagnosed antenatally and postnatally.

Methods Prospective, observational, single-centre study of 110 consecutive cases of pICH identified in the fetal or neonatal period or diagnosed with presumed pICH between 2014 and 2023. Prematurity-related cases were excluded. Antenatal and postnatal MRI data were analysed for patterns and mechanisms of haemorrhage and their potential aetiology. Potential associations between pICH with perinatal and clinical risk factors were also explored.

Results Fifty-nine of the 110 included cases (53.6%) were diagnosed antenatally (termination of pregnancy, n=22), and postnatal data on 81/88 (92%) children were available. Intraventricular haemorrhage (IVH) was the most common haemorrhage type (83/110 (75.5%)) and was more common prenatally (p=0.004). Subpial haemorrhage was exclusively diagnosed postnatally (p<0.001), and it was more commonly detected in primigravida women (p=0.013). The germinal matrix was the most common origin of IVH (n=56, 50.9%) occuring more frequently prenatally (p<0.001), whereas sinus venous thrombosis-related IVH was more commonly detected postnatally (p=0.002). Subdural haemorrhage was associated with haematological abnormalities (p=0.023). Genetic disorders caused 31.9% of the cases (15 of 47 tested cases). Genetic disorders and associated congenital anomalies were more common in the prenatally diagnosed group (p=0.038 and p=0.04, respectively).

Conclusions The patterns and pathogenesis of pICH appear to be different for prenatally and postnatally diagnosed cases and for types of haemorrhages. Given the important role of genetic factors in prenatal intracranial haemorrhage, next-generation sequencing is indicated in these cases.

  • Neurology
  • Neonatology
  • Magnetic Resonance Imaging
  • Genetics

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Contributors Study conception and design: MHK, SIS. Data collection: SL, ITL, AB, MHK, GM, NKH, LB-S, SIS. Analysis and interpretation of results: SL, LB-S, MHK, SIS. Draft manuscript preparation: SL, MHK. All authors reviewed the results and approved the final version of the manuscript. MHK is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.