A term newborn infant with intracranial hemorrhage associated with maternal acetylsalicylic acid ingestion before delivery is reported from the Departments of Pediatrics and Neurology, Eastern Virginia Medical School, Norfolk, VA. Pregnancy was complicated by alcohol abuse. Alka-Seltzer, 6 tablets daily, had been taken for 2 weeks for relief of hangover. The infant’s serum salicylate level at 8 hours was 5.4 mg/dL. Hematocrit decreased from 29% at birth to 15% at 6 hours of age. Prothrombin time was >100 sec. Cranial ultrasound showed hemorrhage in the tentorium and hydrocephalus. CT also revealed a large cerebellar hemorrhage. Clinical findings included multiple ecchymoses, gastric hemorrhage, hematuria, a tense fontanelle, head circumference at the 95th percentile, hypotonia, and ocular bobbing and nystagmus. Transfusion, a second injection of vitamin K, and ventriculoperitoneal shunt were followed by recovery and discharge in care of grandmother on day 23. [1]

COMMENT. Maternal salicylate ingestion should be considered in the etiology of neonatal intracranial hemorrhage without birth trauma. The infant’s relatively low salicylate level is not inconsistent with chronic toxicity.

Surfactant therapy for respiratory distress syndrome in newborns of 600-750 g birth weight caused an increased risk of grades I and II intracranial hemorrhage compared to controls, in analyses of the literature by researchers at Ross Laboratories, Columbus, OH. [2]