Although trauma is the most common cause of hemorrhages observed in newborn infants, the possibility of an underlying coagulopathy or pathological source must be considered. Surgical evacuation of these hematomas is infrequently required. Intracranial hemorrhage is usually classified by location.
Epidural. Usually associated with trauma such as skull fracture or dural venous sinus injury (see Chapter 2, Fig. 2).
Intradural. Rare, but can occur if a tear occurs in cerebellar falx or cerebellar tentorium.
Subdural. Observed in term and premature infants. Traumatic subdural hematomas have been associated with vacuum-assisted and forceps-assisted deliveries, at times occurring with depressed skull fractures (see Chapter 2, Fig. 3). Atraumatic hemorrhage has been reported with stroke and vascular malformations.
Subarachnoid. Very common, with increased incidence in premature infants. Presumed to be caused by shearing forces on cortical vessels. Vasos-pasm does not occur.
Intraparenchymal. Small intraparenchymal hemorrhages may be under-recognized, but are of limited significance. Occasionally, large hemorrhages occur leading to long-term neurological deficits.
Intraventricular. Small amounts of blood within the ventricular system are very common following vaginal delivery, but are of limited significance.
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