Elsevier

Academic Radiology

Volume 16, Issue 5, May 2009, Pages 572-577
Academic Radiology

Radiology alliance health services research
Prevalence and Etiology of Intracranial Hemorrhage in Term Children Under the Age of Two Years: A Retrospective Study of Computerized Tomographic Imaging and Clinical Outcome in 798 Children

https://doi.org/10.1016/j.acra.2009.01.007Get rights and content

Rationale and Objectives

The purposes of this study were to retrospectively identify various etiologies underlying intracranial hemorrhages (ICHs) in term infants aged <2 years and their respective prevalence in this population and to describe the long-term clinical outcomes in these patients.

Materials and Methods

A retrospective review of the medical records and computed tomographic studies of the head in 798 term infants aged 0 to 24 months with suspected or known ICHs was conducted.

Results

ICHs were present in 195 of the 798 infants (24%). More than one type of ICH was present in 32%. Subdural hemorrhage was the most frequent type of ICH, occurring in 63% of the infants. Good clinical outcomes were present in 49% of the infants but varied depending on the location, etiology, and timing of the ICH.

Conclusion

The incidence of various etiologies of ICH depended on the ages of the infants. The overall clinical outcomes were good, with no long-term sequelae in half of the infants presenting with ICHs. In infants aged >4 weeks presenting with ICHs, special attention should be given to the possibility of nonaccidental trauma etiology, because this is common and has worse long-term outcomes.

Section snippets

Patient and Data Collection

Radiologic reports of all head computed tomographic scans performed on infants aged 0 to 730 days (24 months) at our tertiary care center from March 1995 to December 2003 were obtained. The medical charts of the patients were reviewed to determine gestational age at delivery. All infants whose gestational age was not specified and all infants born at or after 37 weeks and 0 days of gestation age were included in this study and designated as term infants. These infants were subdivided into three

Patients

One thousand twenty-six head computed tomographic scans and reports of 798 infants (mean age, 218 days; range, 1–729 days; standard deviation, 215 days) were obtained. Of these infants, 467 (59%) were male and 331 (41%) were female. In 195 of these 798 infants (24%), evidence of ICHs (mean age, 171 days; range, 1–726 days; standard deviation, 193 days) was present on their first computed tomographic scans. In 32% of patients, more than one type of ICH hemorrhage was present. The most frequent

Discussion

Overall, we found that 49% of term infants with ICHs on CT had good clinical outcomes, with no long-term sequelae. However, when the age of the infant at the time of imaging and the underlying etiology are known, the percentage of infants with good clinical outcomes can vary significantly. This finding suggests that with better epidemiologic data, clinicians may be able to provide more informed parent education on long-term clinical outcomes.

The majority of our subjects were scanned after 28

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