Study suggests brain haemorrhage in babies over age one month unlikely from traumatic delivery

UK research in this week's issue of THE LANCET shows how asymptomatic subdural haematomas (bleeding in the brain) among newborn babies are more common than previously thought, are associated with the mode of delivery during childbirth, and are undetectable after a baby is a month old. The latter finding could have implications for the diagnosis of non-accidental injury among infants older than one month of age.

Elspeth Whitby from Sheffield University and Sheffield Teaching Hospitals, UK, and colleagues prospectively assessed the frequency of subdural haemorrhages in full-term babies who did not have any obvious symptoms of haemorrhage, the natural history of any detected haematomas, and identified any associations such as length of labour and mode of delivery on the risk of cerebral bleeding.

111 babies were studied between March 2001 and November 2002. 49 babies were born by normal vaginal delivery, 25 by caesarean section, four with the use of forceps, 13 by the use of suction (ventouse), 18 failed ventouse requiring forceps, one failed ventouse leading to caesarean section, and one failed forceps leading to caesarean section.

Nine babies had subdural haemorrhages: three were normal vaginal deliveries (6% risk), five were delivered by forceps after an attempted ventouse delivery (28% risk), and one had a traumatic ventouse delivery (8% risk). All babies with subdural haemorrhage were assessed clinically but no treatment was needed. All babies with haematoma at birth were rescanned 4 weeks after delivery; all haematomas had completely resolved.

Dr. Whitby comments: "This study is important from the aspect of non-accidental head injury: in a court of law, the defence may claim that an isolated subdural haemorrhage presenting in later infancy is due to a birth injury. Babies with subdural haemorrhage in this study were followed up until age 2 years. A subsequent MRI scan at age 4 weeks showed complete resolution of the haematoma in all babies. Therefore, these lesions seem to be benign, clinically asymptomatic, and of no long-term importance. The medico-legal implications for the finding of asymptomatic isolated subdural haemorrhages in infants older than 4 weeks of age, in whom there is suspicion of non-accidental head injury, are important".

Contact: Dr. Elspeth H. Whitby, c/o Fran Hewitt, Communications Office, Royal Hallamshire Site, Sheffield, UK; T): 44-0-114-271-3453; F): 44-0-114 271-1702; E): Francesca.Hewitt@sth.nhs.uk.

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