Medical expert of the article
New publications
Intracranial hemorrhage in newborns
Last reviewed: 08.07.2025
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Intracranial hemorrhage into the brain tissue or surrounding tissue can occur in any newborn, but is especially common in premature infants; about 20% of premature infants with a birth weight of less than 1500 g have intracranial hemorrhage.
Hypoxic ischemia, fluctuations in blood pressure, and pressure exerted on the head during labor are the main causes. The presence of the caudate germinal layer (embryonic cells located above the caudate nucleus on the lateral wall of the lateral ventricles, found only in the fetus) makes hemorrhage more likely. The risk is also increased by the presence of hematologic disorders (e.g., vitamin K deficiency, hemophilia, disseminated intravascular coagulation - DIC).
Birth trauma such as intracranial hemorrhage in neonates can occur in several spaces of the CNS. Small hemorrhages in the subarachnoid space, falx and tentorium cerebelli are often incidental findings at autopsy of neonates who died from causes not related to the CNS. Large hemorrhages in the subarachnoid or subdural space, brain parenchyma or ventricles are less common, but are more severe.
Subarachnoid hemorrhage is by far the most common type of intracranial hemorrhage. It may present with apnea, seizures, altered consciousness, or neurological deficits in neonates. With large hemorrhages, the accompanying inflammation of the pia mater may lead to the development of communicating hydrocephalus as the infant grows.
Subdural hemorrhage, which is now less common due to improvements in obstetric care, results from rupture of the falx dura mater, tentorium cerebelli, or veins draining into the transverse and superior sagittal sinuses. Such ruptures tend to occur in first-time neonates, large neonates, or after difficult deliveries, conditions that place increased pressure on the intracranial vessels. The first manifestation may be seizures; rapidly enlarging head size; or neurologic deficits such as hypotension, weak Moro reflex, or widespread retinal hemorrhage.
Intraventricular and/or intracerebral hemorrhage usually occurs within the first 3 days of life and is the most severe type of intracranial hemorrhage. Hemorrhages are most common in premature infants, are often bilateral, and typically occur in the germinal layer of the caudate nucleus. Most hemorrhages are subependymal or intraventricular and are small in volume. Large hemorrhages may involve the brain parenchyma or ventricles, with large amounts of blood in the cisterna magna and basalis. Hypoxia-ischemia often precedes intraventricular and subarachnoid hemorrhage. Hypoxic ischemia damages the capillary endothelium, impairs cerebral vascular autoregulation, and may increase cerebral blood flow and venous pressure, either of which may make hemorrhage more likely. Most intraventricular hemorrhages are asymptomatic, but large hemorrhages may cause apnea, cyanosis, or sudden collapse.
[ Diagnosis of intracranial hemorrhage in newborns
Intracranial hemorrhage should be suspected in any neonate with apnea, seizures, altered consciousness, or neurologic abnormalities.
A head CT scan should be ordered. Although head ultrasound is safe, does not require sedation, and can easily detect blood in the ventricles or brain tissue, CT is more sensitive for detecting small amounts of blood in the subarachnoid or subdural space. If the diagnosis is in doubt, cerebrospinal fluid can be examined to detect red blood cells; usually, cerebrospinal fluid contains blood. However, small amounts of red blood cells are often present in the cerebrospinal fluid of full-term infants. In subdural hemorrhage, cranial transillumination may provide the diagnosis after the blood has lysed.
In addition, a coagulogram, complete blood count, and blood chemistry panel should be performed to identify other causes of neurologic dysfunction (eg, hypoglycemia, hypocalcemia, electrolyte disturbances). EEG may help establish the prognosis if the newborn survives the acute hemorrhage period.
Treatment of intracranial hemorrhage in newborns
In most cases, treatment is supportive, except for hematologic causes of hemorrhage. All children should receive vitamin K if not already given. Platelet count or clotting factors are given based on the results of coagulation studies. Subdural hematomas should be treated by a neurosurgeon; blood removal may be necessary.
What is the prognosis for intracranial hemorrhage in newborns?
Subarachnoid hemorrhage usually has a good prognosis. Subdural intracranial hemorrhage in the newborn has a guarded prognosis, but some infants recover. Most infants with small intraventricular hemorrhages survive the acute phase and then recover. Infants with large intraventricular hemorrhages have a poor prognosis, especially if the hemorrhage extends into the parenchyma. Many have residual neurologic symptoms.