Journal List > Korean J Perinatol > v.27(2) > 1013789

Lee, Lee, Ko, Shin, and Han: Clinical Significance of Epidural Hematoma Related to Birth in Newborn

Abstract

Purpose:

Epidural hematoma (EDH) in newborn is very rare, but when it occurs it is usually due to birth injury. We have evaluated the incidence and clinical features of EDH related to birth in newborn.

Methods:

We analyzed medical records of 12 newborns diagnosed with EDH at Cheil General Hospital and Women's Health Care Center from January 2000 to December 2015 retrospectively.

Results:

The incidence of EDH related to birth was 0.01%, occurring in 1 of 10,000 live births. Of the total 12 cases, 10 occurred in male and 8 in vaginal delivery. Among them, 11 infants had evidences of birth injury. Clinical presentation was nonspecific: only 1 infant had neurologic symptoms. The temporooccipital area was the most frequent location of EDH. The median size of EDH was 3.2±0.8 cm in length and 1.2±0.7 cm in depth. Mass effect accompanied with midline shift on radiologic imaging was shown in one case. Surgical drainage was needed only in one infant with neurologic symptom and mass effect on radiologic imaging, while the others were treated conservatively.

Conclusion:

Neonatal EDH related to birth was treated conservatively in most cases. The radiologic mass effect and neurologic symptom should be considered as indication for surgical intervention.

REFERENCES

1). Takagi T., Nagai R., Wakabayashi S., Mizawa I., Hayashi K. Extradural hemorrhage in the newborn as a result of birth trauma. Childs Brain. 1978. 4:306–18.
crossref
2). Noetzel MJ. Perinatal trauma and cerebral palsy. Clin Perinatol. 2006. 33:355–66.
crossref
3). Akiyama Y., Moritake K., Maruyama N., Takamura M., Yamasaki T. Acute epidural hematoma related to cesarean section in a neonate with Chiari II malformation. Childs Nerv Syst. 2001. 17:290–3.
crossref
4). Negishi H., Lee Y., Itoh K., Suzuki J., Nishino M., Takada S, et al. Nonsurgical management of epidural hematoma in neonates. Pediatr Neurol. 1989. 5:253–6.
crossref
5). Halmat A., Heckly A., Adn M., Poulain P. Pathophysiology of intracranial epidural haematoma following birth. Med Hypotheses. 2006. 66:371–4.
6). Aoki N. Epidural hematoma communicating with cephalhematoma in a neonate. Neurosurgery. 1983. 13:55–7.
crossref
7). Aoki N. Epidural haematoma in the newborn infants: therapeutic consequences from the correlation between haematoma content and computed tomography features. A review. Acta Neurochir (Wien). 1990. 106:65–7.
8). Kroon E., Bok LA., Halbertsma F. Spontaneous perinatal epidural haemorrhage in a newborn. BMJ Case Rep. 2012. 2012:pii. bcr0920114735.
crossref
9). Heyman R., Heckly A., Magagi J., Pladys P., Hamlat A. Intracranial epidural hematoma in newborn infants: clinical study of 15 cases. Neurosurgery. 2005. 57:924–9.
crossref
10). Yamamoto T., Enomoto T., Nose T. Epidural hematoma associated with cephalohematoma in a neonate-case report. Neurol Med Chir (Tokyo). 1995. 35:749–52.
11). Vinchon M., Pierrat V., Tchofo PJ., Soto-Ares G., Dhellemmes P. Traumatic intracranial hemorrhage in newborns. Childs Nerv Syst. 2005. 21:1042–8.
crossref
12). Park SM., Oh KW., Kim HM. Correlation between cephalhematomas and intracranial hematomas. J Korean Soc Neo-natol. 2008. 15:160–5.
13). Ciurea AV., Kapsalaki EZ., Coman TC., Roberts JL., Robinson JS 3rd., Tascu A, et al. Supratentorial epidural hematoma of traumatic etiology in infants. Childs Nerv Syst. 2007. 23:335–41.
crossref
14). Hymel KP. Traumatic intracranial injuries can be clinically silent. J Pediatr. 2004. 144:701–2.
crossref
15). Mallet EC., Boumahni B. Neonatal extradural hematoma. Arch Pediatr. 1996. 3:608–9.
16). Mack LA., Wright K., Hirsch JH., Alvord EC., Guthrie RD., Shuman WP, et al. Intracranial hemorrhage in premature infants: accuracy of sonographic evaluation. AJR Am J Roentgenol. 1981. 137:245–50.
17). Bejar R., Curbelo V., Coen RW., Leopold G., James H., Gluck L. Diagnosis and follow-up of intraventricular and intracerebral hemorrhages by ultrasound studies of infant's brain through the fontanelles and sutures. Pediatrics. 1980. 66:661–73.
crossref
18). Babcock DS., Han BK., Weiss RG., Ryckman FC. Brain abnormalities in infants on extracorporeal membrane oxygenation: sonographic and CT findings. AJR Am J Roentgenol. 1989. 153:571–6.
crossref
19). Adcock LM., Moore PJ., Schlesinger AE., Armstrong DL. Correlation of ultrasound with post mortem neuropathologic studies in neonates. Pediatr Neurol. 1998. 19:263–71.
20). Pang D., Horton JA., Herron JM., Wilberger JE Jr., Vries JK. Nonsurgical management of extradural hematomas in children. J Neurosurg. 1983. 59:958–71.
crossref
21). Pozzati E., Tognetti F. Spontaneous healing of acute extradural hematomas: study of twenty-two cases. Neurosurgery. 1986. 18:696–700.
crossref
22). Chen TY., Wong CW., Chang CN., Lui TN., Cheng WC., Tsai MD, et al. The expectant treatment of “asymptomatic” supratentorial epidural hematomas. Neurosurgery. 1993. 32:176–9.
crossref
23). Govaert P. Clinics in developmental medicine. In: Govaert P, Linda S editors. Cranial haemorrhage in the term newborn infant. Epidural haematoma (cephalhematoma internum, internal subperiosteal bleeding). 1st ed.Cambridge: Mac Keith Press;1994. p. 34–40.
24). Ahn DH., Eom KS., Kim DW., Park JT., Moon SK., Kang SD, et al. Traumatic acute epidural hematoma in children. J Korean Neurotraumatol Soc. 2009. 5:11–5.
crossref
25). Dhellemmes P., Lejeune JP., Christiaens JL., Combelles G. Traumatic extradural hematomas in infancy and childhood. Experience with 144 cases. J Neurosurg. 1985. 62:861–4.

Fig. 1
CT scans of case 10. Before (A) and after (B) surgical treatment. The EDH(arrow), shown as a lentiform high-density area on the left temporal region with mass effect(arrowhead), disappeared after surgery.
kjp-27-103f1.tif
Fig. 2
CT scans of case 12. (A) Right parietal EDH (white arrow) without mass effect was shown on day 3. (B) After 2 days, follow-up image was obtained and it showed spontaneously decreased amount of EDH (black arrow) on the same region.
kjp-27-103f2.tif
Table 1.
Summary of Clinical Characteristics and Radiologic Findings of EDH
Patient no. Sex Gestational age Mode of delivery Apgar score (1/5 min) Symptoms CT scan or MRI Treatment Type
Site of EDH (size, cm) Associated lesions
1 M 39+4 V 6/7 Cephalhematoma Respiratory distress R frontal (3.5x3.0x1.0) None medical B
2 M 36+6 V 7/8 Cephalhematoma Respiratory distress L temporooccipital None medical B
3 F 38+5 V 5/7 Respiratory distress L frontal (3.0x2.5x1.0) SAH medical B
4 M 39+4 C 4/6 Respiratory distress R temporal SAH medical B
5 M 35+4 C 7/8 Respiratory distress L parietooccipital (2.0x2.0x0.6) SAH & Parasagitta hemorrhage medical l B
6 M 40+5 V 7/8 Cephalhematoma Respiratory distress L temporooccipital (2.5x0.5) None medical B
7 M 36+4 C 5/8 Respiratory distress L frontal (2.5x2.5x0.4) None medical S
8 M 35+6 V 8/9 Cephalhematoma Respiratory distress L parietal (3.5x3.5x1.0) SDH with Skull fracture (L. parietal) medical B
9 M 39+1 V 8/9 Respiratory distress R temporooccipital (2.6x2x0.7) SDH medical B
10 M 38+2 C 5/7 Seizure Cephalhematoma Respiratory distress L parietal (3.4x3x2.3) (midline shift) Skull fracture (L. temporal) surgical B
11 F 38+5 V 8/9 Cephalhematoma Respiratory distress R temporooccipital (3.8x3.6x1.4) SDH medical B
12 M 39+0 V 8/8 Cephalhematoma Respiratory distress R parietal (4.9x1.9) Skull fracture (R. parietal) medical B

Abbreviations: EDH, epidural hematoma; CT, computerized tomography; MRI, magnetic resonance imaging; M, male; F, female; V, vaginal delivery; C, cesarean section; L, left; R, right; SAH, subarachnoidal hemorrhage; SDH, subdural hemorrhage; B, EDH due to birth trauma; S, spontaneous EDH

TOOLS
Similar articles