Subcortical bruising in the preterm infant

A cranial ultrasound (CUS) was performed on day 2 of a 27week, 3day gestational age newborn, with no external clinical signs or history of trauma during delivery nor concerns of significant thrombocytopenia or coagulopathy, prompted by acute drop in haematocrit (from 17.5 to 11.4 g/dL). Perinatal history was significant for in vitro fertilisation pregnancy, cervical cerclage, pregestational diabetes mellitus, gestational hypertension and premature prolonged membrane rupture, followed by a course of betamethasone and magnesium sulfate, then delivery by stat section for prolapsed cord. Resuscitation was uneventful except for endotracheal intubation lasting 3 hours for surfactant administration, followed by continuous positive airway pressure (CPAP). Initial and subsequent CUS showed several echogenicities grouped in the left subcortical frontoparietal parenchyma (figure 1). Differential diagnoses included heterotopia, calcification or haemorrhage. MRI on day 18 confirmed small areas of parenchymal haemorrhage within left superior frontal subcortical white matter in the T1, T2 and susceptibilityweighted imaging sequences (figure 2). MRI at term equivalent (37 weeks) showed interval evolution with decreased size of lesions. This pattern of injury termed ‘subcortical bruising’ is rare in neonates, and has not been associated in early prematurity. Proposed mechanisms include events during delivery resulting in localised pressure on the brain surface causing compression of venous drainage, leading to selective subcortical injury, especially in the frontal gyrus, in the venous watershed area. The subcortical injury is clearly appreciated in CUS and occurred without concomitant intraventricular or cerebellar haemorrhages. Although developmental outcomes with such injuries have not been reported in literature, serial neurodevelopmental followup is warranted.

• Publication year

  2023

• Venue

  Archives of Disease in Childhood

• Publication date

  2023-05-04

• Fields of study

  Medicine

• Identifiers
  DOI 10.1136/archdischild-2023-325414PMID 37142389
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Neonatal subcortical bruising

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