The authors identified 12 cases of symptomatic intracranial hemorrhage (ICH) among 23,000 infants born at the Beth Israel and Brigham and Women’s Hospitals in Boston, MA, in 1982 and 1983. The incidence of ICH was 5.2/10,000 live births or 5.9/10,000 term appropriate-for-gestation age infants (>-2,500g and >-37 wks gestation). Delivery was spontaneous vaginal in 8, forceps in 3, and cesarean section in 1. Pitocin was used in 5 cases; the indications were induction for postdate in 3 and prolonged second state in 2. Mean Apgar scores at 1 and 5 mins were 5 (range 2-9) and 7 (1-10). Neonatal seizures were the most common presenting symptom, occurring in 7 (60%) infants. Most infants were symptomatic by the second day. Eleven survived the neonatal period. None developed hydrocephalus. The diagnosis of ICH was confirmed by CAT scan. In most cases the hemorrhage was in the subarachnoid space and the CSF obtained by lumbar puncture contained blood. Obstetrical risk, factors were: 1) prolonged second stage of labor (>2 hrs), 2) very rapid labor with rapid descent, and 3) Pitocin and forceps delivery. CAT scan or ultrasound were considered essential for diagnosis of ICH. [1].

COMMENT: Primary subarachnoid hemorrhage (SAH) was the most common form of hemorrhage in a previous study of 22 term newborn infants seen in a 5 year period with intracranial hemorrhage on CT examination [2]. All infants with diffuse SAH had seizures on the first day of life. Five of 10 infants with SAH were born after prolonged labors, traumatic deliveries, and intrauterine asphyxia; three had intrauterine asphyxia. Five of 8 infants with intraventicular hemorrhage (IVH) had difficult deliveries with trauma and asphyxia. In 3 infants with IVH and 3 with intracerebral hemorrhage (ICH) the cause was unexplained, i.e. in almost one-third of the total group. The occurrence of intracranial hemorrhage does not preclude a good outcome. Development was normal or near normal at follow-up in one-half the infants who suffered a SAH and in 3 of 7 with IVH. Seizures in the first week of life are an important sign of SAH, IVH and ICH, occurring in almost all cases.