Parenchymale Hirnblutungen bei reifen Neugeborenen nach unauffälligem Spontanpartus

Background: Symptomatic cerebral hemorrhages occur in mature newborns depending on the method of delivery. The incidence is about 1 : 2000 for unremarkable spontaneous delivery of a primapara. The mortality rate is about 5%. From the patho-physiologic point of view, shear forces affect the venous sinuses during delivery which leads to primarily subdural bleedings in most cases. The most frequent symptoms are apnea and convulsions. Patients: We are reporting on four mature newborns with parenchymal cerebral hemorrhages who were symptomatic within the first 48 h after birth. Results: All patients were born after unremarkable delivery with vertex presentation. Two mothers were gravida I, two were gravida II. In one fetus a dolichocephalus had been found by prenatal ultrasound; after the birth a synostosis of the sagittal suture was diagnosed. No patient had had a pathologic course of labor or signs of asphyxia after birth. The symptoms set in 4-34 h after birth with apnea and convulsions. In all patients the bleeding extended into the parenchyma, only in one patient was the origin of the bleeding primarily in the parenchyma. In two patients, surgical decompression was necessary due to dislocation of the midline and the clinical symptoms. For no patient did the MRI show any other intracranial pathology. A MRI/CT check after 3-4 months showed a substance defect in the area of the bleeding for all patients. A developmental neurological examination was carried out during the period of observation between 14-36 months that was in accordance with the development at that age for all children. Conclusions: Severe intracerebral hemorrhages can occur also after unremarkable spontaneous delivery. The indication for surgical intervention is discussed controversially. Despite detectable substance defects, the prognosis can be good.