Subarachnoid Hemorrhage in Newborns

In newborns, subarachnoid hemorrhages can result from either birth trauma (excessive mechanical force on the baby during birth) or hypoxic-ischemic injury (lack of oxygenated blood flow to the brain) (2, 3). The former is a more common cause in term infants, and the latter in preterm infants (2).

Some factors that can cause birth trauma include mismanagement of an abnormal fetal presentation, improper use of forceps or vacuum extractors, attempts to vaginally deliver babies that will not fit through the mother’s pelvis (see macrosomia and cephalopelvic disproportion), and overuse of the labor-assisting drugs Pitocin and Cytotec. Hypoxia can result from all of the same issues, as well as umbilical cord injuries, uterine rupture, placental abruption, and more. Both birth trauma and hypoxia are often avoidable, and may be caused by medical malpractice.

Signs of a subarachnoid hemorrhage may include:

• Seizures
• Apnea: temporarily ceasing to breathe
• Bradycardia: slow heart rate (3)
• Hydrocephalus: a condition in which fluid builds up in the brain; about 20-30% of infants with subarachnoid hemorrhage develop hydrocephalus (4).

Subarachnoid hemorrhage can be diagnosed with a CT scan, or in non-emergency situations, an MRI (5). Treatment is generally supportive, and includes monitoring neurological signs and seizures, managing seizures, administering intravenous therapy, and preventing further hemorrhage (2). Some may require surgical intervention, such as the insertion of a shunt to treat hydrocephalus (4).

Research has shown that the majority of subarachnoid hemorrhages are minor, and babies usually survive without any lasting problems. Of more serious complications, the most common is posthemorrhagic hydrocephalus. Some cases of massive subarachnoid hemorrhage may result in permanent brain damage or even death (6).