Subarachnoid Hemorrhage – Incidence
Incidences of subarachnoid hemorrhage in babies are highly uncommon. Birth injuries, especially brain trauma, can vary in appearance. Often, infants will have seizures either as soon as they are born, or within the first couple of days after birth. In other instances, children may show no signs of birth injuries until they start missing developmental milestones.
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- He or she favors one side of the body
- The baby is born blue or pale, has a slow heart rate, and/or weak breathing
- He or she exhibits off arm, leg, or facial movements
- A lethargic or sluggish baby
- The baby has no interest in feeding or has difficulty feeding
- He or she has a poor head position
- He or she experiences seizures
- The baby had to be resuscitated at birth
- The baby looks weak or seems to lack muscle tone
Pediatric Subarachnoid Hemorrhage
This kind of hemorrhage tends to be highly uncommon clinical etiology in babies and infants, but one that can have profound and devastating consequences.
Typically, trauma is the most common culprit for this kind of bleeding on the brain, followed by tumors, arteriovenous malformations, and aneurysms.
Disorders During Pregnancy
There are a number of pathological factors that affect the nervous system during pregnancy. Some are rather specific disorders, while others are more common neurologic disorders. For instance, headaches are common during pregnancy and remain one of the most common symptoms of hemorrhaging in babies. There are several conditions during pregnancy that present with seizures, migraines, and focal neurological deficits. The delay of diagnosis could result in a poor outcome for the baby.
There tends to be an association between pregnancy and the risk of a subarachnoid hemorrhage, which is a type of stroke. The incidence of this increases while pregnant, and there have been very few studies conducted to document the risks thereof.
Interestingly, this kind of hemorrhage, or stroke, is the only type with female predominance, which suggests that reproductive factors may well play a role in the etiology. Such pathology has been shown to occur more often in the third trimester of pregnancy.
Furthermore, the endocrine, coagulation, and hemodynamic changes that take place during pregnancy seem to play a central role in the growth and subsequent rupture of aneurysms. Rupture of an aneurysm during pregnancy remains one of the most common causes of this type of hemorrhage in babies. Thankfully, with the momentous developments in prenatal care as well as the management of baby deliveries, non-obstetric reasons of maternal death, like aneurysmal subarachnoid hemorrhage, have become increasingly insignificant.
Case Study
In one particular case study, a series of 10 pregnant women who displayed neurological disorders were admitted to ICU between September 2008 – 2011. All patients were studied with MRI or CT scans, and all were in their third trimester, having had previous normal pregnancies. The presence of an aneurysm in patients with subarachnoid bleeding was confirmed with the use of Digital Subtraction Angiography. Further tests included:
- The Hunt and Hess grading system
- Glasgow coma scale to assess the neurological status
All of the women who endured treatment for burst aneurysms were defined according to the Fischer’s grading system in grades 1 to 4:
- In group 1, no blood was detected
- In group 2, there were no layers of blood greater than 1mm, no clots, and diffuse evidence of subarachnoid blood
- In group 3, localized clots and vertical layers of blood greater than 1mm in thickness were detected
- In group 4, no subarachnoid blood was detected, but certain clots were present
All the patients presented severe headaches, with some presenting seizures, blurred vision, and focal neurological signs. All patients underwent a cesarean section, and all the babies survived, reiterating that this hemorrhaging in babies is very uncommon.