Acute intracranial hematomas in term neonates.

Acute intracranial hematomas in 17 term neonates are reported: 3 were subdural in the posterior fossa; 14 supratentorial, either subdural, intracerebral (1 frontal, 4 occipital) or intraventricular. The hematomas were aspirated in 3 cases and surgically evacuated in 10. In the remaining 4, the effusion was left in situ. Three patients died: 2 due to dramatic preoperative deterioration and 1 to hemostatic difficulties during surgery. In the 14 survivors, neurological sequellae are major in 3, nil or minor in 11. Comparison of these cases to the 110 others already published allows the following conclusions: the cause of such hematomas is usually multifactorial, combining obstetrical trauma, anoxia and/or coagulation disorders; early diagnosis of the hematoma requires early echography and/or tomodensitometry; when the hematoma causes a midline shift, the authors advocate its early evacuation by aspiration, or craniotomy if it is clotted; the prognosis is poor when there is associated severe perinatal anoxia; if there is no anoxia, the prognosis seems good, but as the follow-up is usually short, definite conclusions are difficult; in our series hydrocephalus requiring treatment occurred in 2 of the 14 survivors.