To describe the spectrum of intracranial hemorrhage in late pre-term and term neonates.

Intracranial hemorrhages (ICH) in neonates range from asymptomatic to potentially devastating. With differing pathophysiology of the intracranial compartments, ICH data is typically specific to the compartment involved. We investigate the distribution of ICH types across term and late-preterm neonates at one institution.

Term and late-preterm neonates (gestational age (GA) >34 weeks) with ICH on MRI brain consecutively from January 2011 to August 2018 were included. Neonates with meningitis, ischemic infarct, venous thrombosis, or hypoxic ischemic encephalopathy (HIE) alone were excluded. Patient data included GA, delivery method, Apgar scores, seizures, and clinical diagnosis of HIE. MRI data included indication, type of ICH (intraventricular, subarachnoid, subdural, intraparenchymal, and subpial/leptomeningeal), MRA and MRV.

From a total of 725 eligible neonates (576 term and 149 late preterm) with MRI during the study period, 59 met inclusion criteria with a median GA of 38.9 (IQR 37.0-39.8). 19 (32%) were delivered via cesarean section, with 5 (8%) delivered via instrumented delivery. Indication for MRI was HIE in 11 (19%) and clinical seizures in 15 (25%).

Intraventricular hemorrhage and subdural hemorrhage were the most common types of intracranial hemorrhage, occurring in 40 (68%) and 38 (64%) respectively. Intraparenchymal hemorrhage occurred in 26 (44%), subpial in 13 (22%), subarachnoid in 10 (17%), and epidural in 1 (2%). 47 (80%) had more than one type of hemorrhage. 22 (37%) underwent MRA and 23 (39%) underwent MRV, with abnormal findings on 2 MRAs and 5 MRVs.

Amongst a sample of 59 term and late-preterm neonates with intracranial hemorrhage, intraventricular hemorrhage and subdural hemorrhage were the most common types. This is the largest reported sample categorizing intracranial hemorrhage in term and late-preterm neonates to date.