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Alemayehu T, Gebre T, Asmare B, Tafere Y, Kassie B, Tsega TD, Alemu M, Messelu MA. Incidence and predictors of neonatal seizures among neonates admitted in Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia. A prospective follow-up study. Heliyon 2024; 10:e29999. [PMID: 38707374 PMCID: PMC11066383 DOI: 10.1016/j.heliyon.2024.e29999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Neonatal seizures are the most common neurological problem among newborns. To date, scientific studies on the incidence and predictors of neonatal seizures in African countries, including Ethiopia are scarce. Therefore, this study aimed to assess the incidence and predictors of neonatal seizures among neonates admitted to Debre Markos comprehensive Specialized Hospital. Methods An institutional-based prospective follow-up study was conducted in Debre Markos comprehensive specialized hospital from February 1, 2022 to January 30, 2023. A systematic random sampling technique was used to select a total of 198 neonates. Data were entered into Epi-Data 4.2 and then exported to STATA version 14.1 for analysis. The Kaplan-Meier survival curve and the log-rank test were computed to explore the descriptive statistics. Variables with a p-value ≤0.2 in bi-variable Cox-regression were selected for multivariable Cox-regression analysis. Finally, a p-value of <0.05 was used to declare the statistical significance of the association with the outcome variable. Results The overall incidence rate of neonatal seizures was 35 per 1000 person-day observations. The mean follow-up time for this study was 123.4 h. The cumulative survival probability of neonates' at 0 to 24 and 0-72 h was 89.8 % and 81.71 %, respectively. The statistically significant predictors for the incidence of neonatal seizures were perinatal asphyxia (AHR = 10.95; 95%CI: 4.81, 24.93), subgaleal hemorrhage (AHR = 5.17; 95%CI: 2.09, 12.79), and gestational age <37 weeks (AHR = 4.62; 95%CI: 1.62, 13.22). Conclusions The incidence rate of neonatal seizures in this study was high. Neonates born with gestational age <37 weeks, having perinatal asphyxia, and having subgaleal hemorrhage were statistical predictors for the incidence of neonatal seizures. Thus, healthcare professionals should give special attention to neonates born with gestational age <37 weeks, prevent perinatal asphyxia and subgaleal hemorrhage.
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Affiliation(s)
- Tefera Alemayehu
- Debre Markos Comprehensive Specialized Hospital, Debre Markos, Ethiopia
| | - Tsige Gebre
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Bayachew Asmare
- Department of Human Nutrition, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Yilkal Tafere
- Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Bekalu Kassie
- Department of Midwifery, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Tilahun Degu Tsega
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Mulu Alemu
- Debre Markos Comprehensive Specialized Hospital, Debre Markos, Ethiopia
| | - Mengistu Abebe Messelu
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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2
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Allen J, Spinks J, Stedman J. Acute soft head syndrome in sickle cell disease. Arch Dis Child 2023; 108:774. [PMID: 37463737 DOI: 10.1136/archdischild-2023-325704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 07/20/2023]
Affiliation(s)
- Jasmine Allen
- Paediatrics, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Joanne Spinks
- Paediatrics, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Jonathan Stedman
- Radiology Department, Royal Berkshire NHS Foundation Trust, Reading, UK
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Neonatal bilateral adrenal hemorrhage and adrenal insufficiency accompanied by Subgaleal hematoma: a case report with brief review of literature. BMC Pediatr 2022; 22:248. [PMID: 35513814 PMCID: PMC9069721 DOI: 10.1186/s12887-022-03314-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/27/2022] [Indexed: 11/18/2022] Open
Abstract
Background Neonatal adrenal hemorrhage (NAH) is an almost infrequent phenomenon (0.2–0.55%). Mechanical compression and alterations of venous pressure during delivery are considered the most probable explanations. Approximately 10% of the cases might have bilateral involvement. Clinical symptoms include abdominal mass, poor feeding, vomiting, prolonged jaundice, and anemia. Subgaleal hemorrhage (SGH) is one of the most clinically remarkable and potentially hazardous postnatal cranial injuries. Case presentation An early-term Iranian male neonate who was born through spontaneous vaginal delivery and experienced shoulder dystocia was diagnosed with bilateral NAH leading to adrenal insufficiency requiring glucocorticoid and mineralocorticoid supplementation. The SGH and jaundice were other postnatal complications. Serial monthly abdominal and brain ultrasound revealed complete regression of lesions after 70 days. However, after 16 months, the neonate has been still treated with hydrocortisone and fludrocortisone for the adrenal insufficiency diagnosis. He has a lower limit weight for age; however, developmental milestones have been appropriate for age. Discussion and conclusion Adrenal hemorrhage and SGH should be examined and looked for, particularly with proven evidence of difficult delivery and asphyxia in at-risk newborns. Clinical and ultrasound follow-up is mandatory for the assessment of hemorrhage resolution and conservative management. The early detection and treatment of adrenal insufficiency by laboratory examination is strongly recommended in bilateral cases. Furthermore, the early recognition of postnatal SGH to prevent clinical and neurological outcomes seems essential.
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Subgaleal Haematoma After Instrumental Delivery: Another Unexpected Complication of a Cost-Saving Version of Thierry's Spatulas. J Gynecol Obstet Hum Reprod 2022; 51:102356. [PMID: 35304291 DOI: 10.1016/j.jogoh.2022.102356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/02/2022] [Accepted: 03/13/2022] [Indexed: 11/22/2022]
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Prediction of neonatal subgaleal hemorrhage using first stage of labor data: a machine-learning based model. J Gynecol Obstet Hum Reprod 2022; 51:102320. [DOI: 10.1016/j.jogoh.2022.102320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/11/2022] [Accepted: 01/16/2022] [Indexed: 11/21/2022]
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6
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Sandoval Karamian AG, Mercimek-Andrews S, Mohammad K, Molloy EJ, Chang T, Chau V, Murray DM, Wusthoff CJ. Neonatal encephalopathy: Etiologies other than hypoxic-ischemic encephalopathy. Semin Fetal Neonatal Med 2021; 26:101272. [PMID: 34417137 DOI: 10.1016/j.siny.2021.101272] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Neonatal encephalopathy (NE) describes the clinical syndrome of a newborn with abnormal brain function that may result from a variety of etiologies. HIE should be distinguished from neonatal encephalopathy due to other causes using data gathered from the history, physical and neurological exam, and further investigations. Identifying the underlying cause of encephalopathy has important treatment implications. This review outlines conditions that cause NE and may be mistaken for HIE, along with their distinguishing clinical features, pathophysiology, investigations, and treatments. NE due to brain malformations, vascular causes, neuromuscular causes, genetic conditions, neurogenetic disorders and inborn errors of metabolism, central nervous system (CNS) and systemic infections, and toxic/metabolic disturbances are discussed.
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Affiliation(s)
- A G Sandoval Karamian
- Children's Hospital of Philadelphia, Division of Neurology, 3501 Civic Center Blvd Office 1200.12, Philadelphia, PA, 19104, USA.
| | - S Mercimek-Andrews
- Biochemical Geneticist, Department of Medical Genetics, University of Alberta, 8-39 Medical Sciences Building, 8613 - 144 Street, Edmonton, T6G 2H7, Alberta, Canada.
| | - K Mohammad
- Cumming School of Medicine, University of Calgary, Alberta Children's Hospital, Room B4-286, 28 Oki drive NW, Calgary, AB, T3B 6A8, Canada.
| | - E J Molloy
- Trinity College, the University of Dublin, Trinity Translational Medicine Institute, Dublin, Ireland; Children's Health Ireland at Tallaght and Crumlin & and Coombe Women's and Infants University Hospital, Dublin, Ireland; Trinity Research in Childhood Centre (TRiCC), Trinity Academic Centre, Tallaght University Hospital, Dublin 24, Ireland.
| | - T Chang
- George Washington University School of Medicine & Health Sciences, Washington, DC, 20010, USA; Neonatal Neurology Program, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA.
| | - Vann Chau
- Neurology, Neonatal Neurology Program, The Hospital for Sick Children, 555 University Avenue, Toronto ON, M5G 1X8, Canada.
| | - D M Murray
- Deptartment of Paediatric and Child Health, University College Cork, ARm 2.32, Paediatric Academic Unit, Floor 2, Seahorse Unit, Cork University Hospital, Wilton, Cork, T12 DCA4, Ireland.
| | - Courtney J Wusthoff
- Division of Child Neurology, Division of Pediatrics- Neonatal and Developmental Medicine, Stanford Children's Health, 750 Welch Road, Suite 317, Palo Alto, CA, 94304 USA.
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7
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Andresen F, Zieger B, Würtemberger U, Kunze M, Hentschel R. [The Neonatal Subgaleal Hematoma - A Neonatal Emergency]. Z Geburtshilfe Neonatol 2021; 225:529-533. [PMID: 34198347 DOI: 10.1055/a-1498-2817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Subgaleal hematoma (SGH) is a rare complication in neonates that may lead to hemorrhagic shock due to significant blood loss into the subgaleal space. We report of two neonates who developed subgaleal hematoma with severe hemorrhagic shock and encephalopathy. In the first case of a mature female neonate, the development of the subgaleal hematoma was promoted by early-onset sepsis and delivery by vacuum extraction. The second case, of a male preterm neonate, was a complicated fetal development followed by secondary cesarean section. Both cases highlight that a subgaleal hematoma is a severe neonatal emergency. In addition to prompt treatment of the shock, therapy of the coagulopathy is essential.
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Affiliation(s)
- Felicia Andresen
- Klinik für Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Freiburg, Freiburg
| | - Barbara Zieger
- Klinik für Pädiatrische Hämatologie und Onkologie, Sektion Hämostaseologie, Universitätsklinikum Freiburg, Freiburg
| | - Urs Würtemberger
- Klinik für Neuroradiologie, Universitätsklinikum Freiburg, Freiburg
| | - Mirjam Kunze
- Frauenklinik, Universitätsklinik Freiburg, Freiburg
| | - Roland Hentschel
- Klinik für Allgemeine Kinder- und Jugendmedizin, Sektion Neonatologie/Pädiatrische Intensivmedizin, Universitätsklinikum Freiburg, Freiburg
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Levin G, Rosenbloom JI, Sultani M, Meyer R, Porat S, Ofek-Shlomai N, Yagel S, Rottenstreich A. The role of sonographic head circumference in the occurrence of subgaleal hemorrhage following vacuum delivery. J Matern Fetal Neonatal Med 2021; 35:5450-5455. [PMID: 33535839 DOI: 10.1080/14767058.2021.1882983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Subgaleal hemorrhage (SGH) is a severe neonatal morbidity that is associated with vacuum-assisted delivery (VAD). Large sonographic head circumference (sHC) was previously associated with complicated VAD. Nevertheless, the association of large sHC with SGH formation following VAD is underreported. We aim to evaluate the role of sonographic head circumference (sHC) with SGH formation following attempted VAD. METHODS A retrospective case-control study. Cases comprised singleton pregnancies for whom attempted VAD resulted in SGH with an sHC measured within 2 weeks from delivery. Controls were VAD deliveries which not resulted in SGH, with an sHC measured within 2 weeks from delivery. We matched controls in a 1:1 ratio by gestational age, parity and year of delivery. RESULTS Overall, 118 women were included in the SGH study group and were matched to 118 controls. Baseline maternal and fetal characteristics were similar between the groups except for higher neonatal birth weight in the SGH group (median 3422 vs. 3195 grams, p = .001). sHC did not vary between groups (median 336 mm in SGH groups vs. 333, p = .08). Rate of sHC >90th and >95th percentile did not significantly differ between the groups (13.6% vs. 8.5%, 6.8% vs. 3.4%, p = .21, p = .37, for SGH vs. controls, respectively). In multivariate regression analysis, sHC was not found to be independently associated with SGH - aOR (95% CI) 1.004 (0.97-1.03). Receiver operating characteristic curves of sHC for SGH formation underlined an area under the curve of 0.58 (95% CI) (0.51-0.65). CONCLUSIONS sHC is not associated with SGH formation following VAD.
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Affiliation(s)
- Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Joshua I Rosenbloom
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Raanan Meyer
- The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shay Porat
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Noa Ofek-Shlomai
- Department of Neonatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Pettersson KA, Westgren M, Blennow M, Ajne G. Association of traction force and adverse neonatal outcome in vacuum-assisted vaginal delivery: A prospective cohort study. Acta Obstet Gynecol Scand 2020; 99:1710-1716. [PMID: 32644188 DOI: 10.1111/aogs.13952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 06/24/2020] [Accepted: 06/27/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Traction force is a possible risk factor for adverse neonatal outcome in vacuum extraction delivery, but the knowledge is scarce and further investigation is needed. Our hypothesis was that high-level traction force increases the risk of admission to the neonatal intensive care unit. MATERIAL AND METHODS The study was a hospital-based prospective cohort study on low- and mid-vacuum extractions at the labor and delivery ward, Karolinska University Hospital, Huddinge, Sweden. Traction forces were measured in 331 women. An electronical handle was used to measure and register traction force. The main exposure variable was high-level traction force (≥75th percentile) during the first three pulls and the primary outcome was admission to the neonatal intensive care unit. Logistic regression was used to estimate the adjusted risk. RESULTS Among the exposed, 14/84 (16.7%) were admitted to neonatal intensive care, and among the unexposed 10/247 (4%). The crude odds ratio (OR) of admission to the neonatal intensive care unit when exposed to high-level traction force was 4.7, and the adjusted (birthweight, gestational length, cup detachment, number of pulls, duration, duration >15 minutes, mid-cavity fetal head station, failed extraction, indication and parity) OR was 2.85 (95% confidence interval [CI] 1.09-7.48). No significant effect was seen in Apgar scores <7 at 5 minutes or pH <7.1. CONCLUSIONS High-level traction force may be a risk factor for neonatal complications. Although these results do not mandate any alterations in clinical guidelines, perioperative feedback on traction force may be useful to alert the obstetrician to a timely conversion to cesarean section. To study plausible traction force specific outcomes such as head traumas, a larger sample size is required.
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Affiliation(s)
- Kristina A Pettersson
- Children and Women's Health, Karolinska University Hospital, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Clintec, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Westgren
- Department of Obstetrics and Gynecology, Clintec, Karolinska Institutet, Stockholm, Sweden
| | - Mats Blennow
- Children and Women's Health, Karolinska University Hospital, Stockholm, Sweden.,Department of Pediatrics, Clintec, Karolinska Institutet, Stockholm, Sweden
| | - Gunilla Ajne
- Children and Women's Health, Karolinska University Hospital, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Clintec, Karolinska Institutet, Stockholm, Sweden
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Levin G, Mankuta D, Eventov-Friedman S, Ezra Y, Koren A, Yagel S, Rottenstreich A. Factors associated with the severity of neonatal subgaleal haemorrhage following vacuum assisted delivery. Eur J Obstet Gynecol Reprod Biol 2020; 245:205-209. [DOI: 10.1016/j.ejogrb.2019.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/22/2019] [Indexed: 12/01/2022]
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Neonatal subgaleal hemorrhage unrelated to assisted vaginal delivery: clinical course and outcomes. Arch Gynecol Obstet 2019; 301:93-99. [PMID: 31768745 DOI: 10.1007/s00404-019-05392-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the occurrence of subgaleal hemorrhage (SGH) following non-assisted vaginal delivery (normal vaginal delivery or cesarean delivery), and to characterize associated factors, clinical course, and outcomes, compared to attempted assisted vaginal delivery (AVD)-associated SGH METHODS: A retrospective cohort study was conducted. All cases of SGH encountered following delivery of a singleton neonate at Hadassah, Hebrew University Medical Center during 2011-2018 were included. Maternal, fetal, intrapartum, and neonatal characteristics and outcomes were compared between AVD-related and non-AVD-related SGH groups. RESULTS The overall incidence of SGH was 4.5/1000 (369/82,256) singleton deliveries. The incidences of AVD- and non-AVD-related SGH were 44.6/1000 (350/7852) and 0.3/1000 (19/74,404) singleton deliveries, respectively. Ten (53%) of the 19 non-AVD-related SGH were diagnosed after vaginal delivery and 9 (47%) after an urgent cesarean section. SGH severity was mild, moderate, and severe in 68%, 16%, and 16% of the cases, respectively. SGH severity did not differ between the attempted AVD group and the non-AVD-related SGH group. A higher proportion of neonates with non-AVD SGH required phototherapy treatment than did those diagnosed with AVD-related SGH (56% vs. 24%, P = 0.003). Other neonatal outcomes, including Apgar scores, maximal bilirubin level, length of stay, and the rate of composite adverse outcomes, did not differ between the groups. CONCLUSIONS SGH, although rare, may be diagnosed after unassisted vaginal or cesarean delivery in the absence of an AVD attempt. We advocate continuing education for all medical staff who participate in peripartum and neonatal care, regarding the possible occurrence of non-AVD-related SGH.
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12
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Encephalopathy in neonates with subgaleal hemorrhage is a key predictor of outcome. Pediatr Res 2019; 86:234-241. [PMID: 30999320 DOI: 10.1038/s41390-019-0400-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/07/2019] [Accepted: 04/06/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Subgaleal hemorrhage (SGH) is reported to be associated with severe hemodynamic instability, coagulopathy, and even mortality. The importance of the presence or absence of neonatal encephalopathy in predicting SGH outcomes has not been explored. The aim of this study was to determine the relationship of clinical encephalopathy to short-term outcomes in neonates with SGH. METHODS Neonates ≥35 weeks gestation, diagnosed radiologically with SGH between 2010 and 2017, were included. Cases were divided into encephalopathic and non-encephalopathic. Demographic, clinical, and outcome data were compared between groups. RESULTS Of 54,048 live births, 56 had SGH, of them 13 (23%) had encephalopathy. When compared to the non-encephalopathic neonates, encephalopathic neonates had lower Apgar scores, lower hemoglobin, lower platelet count, longer neonatal intensive care unit stay, two (15%) deaths, and four (31%) required blood transfusion. No non-encephalopathic infant with SGH died or required blood transfusion. Notably, on magnetic resonance imaging (MRI), a majority of subgaleal collections had either no or minimal blood products. CONCLUSIONS In the absence of encephalopathy, SGH is not associated with adverse short-term outcome. Neurological assessment is likely to identify infants at higher risk for adverse outcome. The absence of MRI signal consistent with blood in subgaleal collection warrants further research.
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13
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Levin G, Elchalal U, Yagel S, Eventov-Friedman S, Ezra Y, Sompolinsky Y, Mankuta D, Rottenstreich A. Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction. Acta Obstet Gynecol Scand 2019; 98:1464-1472. [PMID: 31220332 DOI: 10.1111/aogs.13678] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/14/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Subgaleal hemorrhage (SGH) is a life-threatening neonatal condition that is strongly associated with vacuum assisted delivery (VAD). The factors associated with the development of SGH following VAD are not well-established. We aimed to evaluate the factors associated with the development of SGH following attempted VAD. MATERIAL AND METHODS A retrospective case-control study of women who delivered at a tertiary university-affiliated medical center in Jerusalem, Israel, during 2009-2018. Cases comprised all parturients with singleton pregnancies for whom attempted VAD resulted in neonatal SGH. A control group of VAD attempts was established by matching one-to-one according to gestational age at delivery, parity and year of delivery. Fetal, intrapartum and vacuum procedure characteristics were compared between the groups. RESULTS In all, 313 (89.5%) of the 350 attempted VAD were nulliparous. Baseline maternal and fetal characteristics were similar between the groups except for higher neonatal birthweight in the SGH group. In multivariate logistic regression analysis, only six independent risk factors were significantly associated with the development of SGH: second-stage duration (for each 30-minute increase, adjusted odds ratio [OR] 1.13; 95% confidence intervals [CI] 1.04-1.25; P = .006), presence of meconium-stained amniotic fluid (adjusted OR 2.61; 95% CI 1.52-4.48; P = .001), presence of caput succedaneum (adjusted OR 1.79; 95% CI 1.11-2.88; P = .01), duration of VAD (for each 3-minute increase, adjusted OR 2.04; 95% CI 1.72, 2.38; P < .001), number of dislodgments (adjusted OR 2.38; 95% CI 1.66-3.44; P < .001), and fetal head station (adjusted OR 3.57; 95% CI 1.42-8.33; P = .006). Receiver operating characteristic curves showed that VAD duration of ≥15 minutes had a 96.7% sensitivity and 75.0% specificity in predicting SGH formation, with an area under the curve equal to .849. CONCLUSIONS Vacuum duration, the number of dislodgments, the duration of second stage of delivery, fetal head station, the presence of caput succedaneum and the presence of meconium were found to be independently associated with SGH formation.
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Affiliation(s)
- Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Uriel Elchalal
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Yossef Ezra
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yishay Sompolinsky
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Mankuta
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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14
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Lee SJ, Kim JK, Kim SJ. The clinical characteristics and prognosis of subgaleal hemorrhage in newborn. KOREAN JOURNAL OF PEDIATRICS 2018; 61:387-391. [PMID: 30304906 PMCID: PMC6313086 DOI: 10.3345/kjp.2018.06800] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/03/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Subgaleal hemorrhage (SGH) is a rare but potentially fatal condition in newborns; however, few studies have reported on this condition. We aimed to identify the clinical characteristics and prognostic factors of SGH. METHODS We retrospectively reviewed the medical records of 20 neonates diagnosed with SGH between January 2000 and June 2017. Enrolled neonates were clinically diagnosed when they had tender fluctuant scalp swelling that crossed the suture lines. RESULTS Among 20 neonates with SGH, 12 were boys and 7 were girls; median hospitalization duration was 9.7±6.9 days. Fourteen neonates (70%) were born via vacuum-assisted vaginal delivery, and 4 via vacuum-assisted cesarean section. Of the neonates enrolled, half of them initially showed unstable vital signs, including apnea, desaturation, and cyanosis. Ten neonates had acidosis and 3 had asphyxia (pH<7.0). Intracranial lesions associated with SGH were observed in 15 neonates (75%), including subdural hemorrhage (50%), subarachnoid hemorrhage (15%), intraventricular hemorrhage (5%), cerebral infarct (15%), skull fracture (30%), and cephalohematoma (20%). Twelve neonates (60%) required transfusion, 5 (25%) had seizures, and 3 (15%) died. Eight neonates (40%) had hyperbilirubinemia (mean total bilirubin, 13.1±7.4). The mean follow-up period was 8.4±7.5 months. At follow-up, 10 neonates (58.8%) were healthy with normal development, whereas 7 (41.2%) had neurological deficits. CONCLUSION The morbidity rate was 41.2% due to severe metabolic acidosis. Anemia, hyperbilirubinemia, low Apgar scores, and subdural hemorrhage did not affect the prognosis. The long-term outcomes of neonates with SGH are generally good. Only arterial blood pH was significantly associated with death.
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Affiliation(s)
- Sun Jin Lee
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea
| | - Jin Kyu Kim
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea.,Biomedical Research Institute of Chonbuk National University, Jeonju, Korea
| | - Sun Jun Kim
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea.,Biomedical Research Institute of Chonbuk National University, Jeonju, Korea
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15
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Ekéus C, Wrangsell K, Penttinen S, Åberg K. Neonatal complications among 596 infants delivered by vacuum extraction (in relation to characteristics of the extraction). J Matern Fetal Neonatal Med 2017. [DOI: 10.1080/14767058.2017.1344631] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Cecilia Ekéus
- Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Katarina Åberg
- Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Stockholm, Sweden
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Pettersson K, Yousaf K, Ranstam J, Westgren M, Ajne G. Predictive value of traction force measurement in vacuum extraction: Development of a multivariate prognostic model. PLoS One 2017; 12:e0171938. [PMID: 28257459 PMCID: PMC5336195 DOI: 10.1371/journal.pone.0171938] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 01/29/2017] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To enable early prediction of strong traction force vacuum extraction. DESIGN Observational cohort. SETTING Karolinska University Hospital delivery ward, tertiary unit. POPULATION AND SAMPLE SIZE Term mid and low metal cup vacuum extraction deliveries June 2012-February 2015, n = 277. METHODS Traction forces during vacuum extraction were collected prospectively using an intelligent handle. Levels of traction force were analysed pairwise by subjective category strong versus non-strong extraction, in order to define an objective predictive value for strong extraction. STATISTICAL ANALYSIS A logistic regression model based on the shrinkage and selection method lasso was used to identify the predictive capacity of the different traction force variables. PREDICTORS Total (time force integral, Newton minutes) and peak traction (Newton) force in the first to third pull; difference in traction force between the second and first pull, as well as the third and first pull respectively. Accumulated traction force at the second and third pull. OUTCOME Subjectively categorized extraction as strong versus non-strong. RESULTS The prevalence of strong extraction was 26%. Prediction including the first and second pull: AUC 0,85 (CI 0,80-0,90); specificity 0,76; sensitivity 0,87; PPV 0,56; NPV 0,94. Prediction including the first to third pull: AUC 0,86 (CI 0,80-0,91); specificity 0,87; sensitivity 0,70; PPV 0,65; NPV 0,89. CONCLUSION Traction force measurement during vacuum extraction can help exclude strong category extraction from the second pull. From the third pull, two-thirds of strong extractions can be predicted.
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Affiliation(s)
- Kristina Pettersson
- Obstetrics and gynecology, Karolinska University Hospital, Stockholm, Sweden
- Clintec, Karolinska Institute, Stockholm, Sweden
- * E-mail:
| | - Khurram Yousaf
- Clintec, Karolinska Institute, Stockholm, Sweden
- School of Technology and Health, Royal Institute of Technology, Stockholm, Sweden
| | - Jonas Ranstam
- Statistician, Swedish Patient Insurance, Stockholm, Sweden
| | - Magnus Westgren
- Obstetrics and gynecology, Karolinska University Hospital, Stockholm, Sweden
- Clintec, Karolinska Institute, Stockholm, Sweden
| | - Gunilla Ajne
- Obstetrics and gynecology, Karolinska University Hospital, Stockholm, Sweden
- Clintec, Karolinska Institute, Stockholm, Sweden
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Modanlou H, Hutson S, Merritt AT. Early Blood Transfusion and Resolution of Disseminated Intravascular Coagulation Associated with Massive Subgaleal Hemorrhage. Neonatal Netw 2016; 35:37-41. [PMID: 26842538 DOI: 10.1891/0730-0832.35.1.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A male infant delivered to a primipara woman following vacuum applications. He was vigorous at birth, with small caput and scalp bruising. His head was enlarging; he became pale with respiratory distress. Subgaleal hemorrhage (SGH) was suspected. His hematocrit was noted to be 26.2 percent prior to transfusion of O, Rh-negative blood (40 mL/kg). Moderate disseminated intravascular coagulation (DIC) was noted at 12 hours of age. Posttransfusion of fresh frozen plasma (FFP), his condition became stable, and DIC gradually resolved. Head magnetic resonance imaging did not show intracranial hemorrhage. Although one episode of seizures was noted, electroencephalogram was normal. With the application of obstetric vacuum, we recommend that the neonatal health care professionals frequently evaluate the infant's condition. In light of developing fluctuant subgaleal fluid associated with pallor, anemia, metabolic acidosis, and respiratory distress, immediate blood transfusion is warranted. In the presence of DIC, transfusion of FFP is beneficial.
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Ferreira N, Proença E, Godinho C, Oliveira D, Guedes A, Morais S, Carvalho C. Neonatal Hemophilia: A Rare Presentation. Pediatr Rep 2015; 7:6338. [PMID: 26734126 PMCID: PMC4689991 DOI: 10.4081/pr.2015.6338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/17/2015] [Indexed: 11/23/2022] Open
Abstract
Hemophilia A is a X-linked hereditary condition that lead to decreased factor VIII activity, occurs mainly in males. Decreased factor VIII activity leads to increased risk of bleeding events. During neonatal period, diagnosis is made after post-partum bleeding complication or unexpected bleeding after medical procedures. Subgaleal hemorrhage during neonatal period is a rare, severe extracranial bleeding with high mortality and usually related to traumatic labor or coagulation disorders. Subgaleal hemorrhage complications result from massive bleeding. We present a neonate with unremarkable family history and uneventful pregnancy with a vaginal delivery with no instrumentation, presenting with severe subgaleal bleeding at 52 hours of life. Aggressive support measures were implemented and bleeding managed. The unexpected bleeding lead to a coagulation study and the diagnosis of severe hemophilia A. There were no known sequelae. This case shows a rare hemophilia presentation reflecting the importance of coagulation studies when faced with unexplained severe bleeding.
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Affiliation(s)
| | | | | | | | | | - Sara Morais
- Clinical Hematology Department, Centro Hospitalar do Porto , Portugal
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