Amer J Perinatol
DOI: 10.1055/s-0037-1608927
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Prevalence and Characteristics of Intracranial Hemorrhages in Neonates with Hypoxic Ischemic Encephalopathy

Rani A. Bashir1, Sakeer Vayalthrikkovil1, Liza Espinoza2, Leigh Irvine2, James Scott3, Khorshid Mohammad2
  • 1Section of Neonatology, Renai Medicity, Kochi, Kerala, India
  • 2Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
  • 3Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada
Further Information

Publication History

21 August 2017

26 October 2017

Publication Date:
08 December 2017 (eFirst)


Introduction The risk factors of intracranial hemorrhages (ICH) in the context of neonatal hypoxic ischemic encephalopathy (HIE) and related interventions are unclear.

Objective This article examines the prevalence and risk factors associated with ICH in neonates with HIE.

Study Design This is a retrospective cohort study of neonates with HIE in Southern Alberta. ICH (subdural [SDH], subarachnoid [SAH], intraventricular [IVH], intraparenchymal [IPH]) were diagnosed by magnetic resonance imaging (MRI). Perinatal and neonatal characteristics were examined. Relation of hemorrhages with hypoxic changes on MRI and HIE stages were assessed.

Results Number of HIE patients, n = 157; brain MRI was done in 138 infants; median gestation, 40 weeks; and cooled = 103 (66%). Prevalence of SDH, IPH, IVH, and SAH were 47, 22, 11, and 10 (34.1%, 15.9%, 7.8%, 7.2%), respectively. There was no significant increase in hemorrhage with mode of delivery, seizures, hypo/hypercarbia, severe thrombocytopenia, or deranged coagulation. All hemorrhages increased with higher HIE stage, regardless of the HIE severity in MRI. Adjusting for HIE staging, cooling, and gestation, IPH was observed more in infants who received inotropes (odds ratio [OR], 3.32; 95% confidence interval [CI], 1.20, 9.20).

Conclusion SDH followed by IPH were the most common ICH. Thrombocytopenia and deranged coagulation did not increase risk of hemorrhages in HIE. Our study was not powered to determine the impact of inotrope use on the risk of IPH.