الفهرس 
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Abstract
Intracranial hemorrhage (ICH) in neonates is an acquired lesion with enormous potential impact on morbidity , mortality , and long-term neurodevelopmental outcome. Despite considerably improved neonatal care and increased survival of preterm infants over recent decades , ICH continues to be a significantly worrisome problem .
This study aimed to study the prevalence of ICH in neonates without any neurological signs detected and to determine the different obstetric and neonatal risk factors associated with the development of ICH
This case-control study was conducted on 120 newborns , were admitted to the NICU of Gynecology and Obstetric Hospital Ain Shams University during the study period from June 2009 to December 2009 . There were 42.9 % males and 21.1% females had ICH , in which their mean GA was 32.82 weeks and their mean birth weight was 1.95 Kg .
After taking written consent from the parents for participatingin this study , All neonates were subjected to:
1- Detailed history taking : maternal , obstetric and delivery
circumstance laying stress on maternal and obstetric risk factors
of ICH e.g. hypertension . diabetes mellitus, pulmonary disease
malpresentation , multiple pregnancy , polyhydraminous ,
placental abnormalities , premature rupture of membranes
( PROM), prolonged labor , assisted vaginal delivery ( forceps or
vacuum extraction ) , CS delivery .
2- Assessment of the general condition using Apgar score at 1,5 min.
3- Assessment of GA using Ballard score1991 .
4- Recording birth weight .
5- Thorough clinical examination laying stress on neurological
examination according to Sarnat and Sarnat, 1976 .
6- Routine laboratory investigation including , CBC , CRP and ABG,
at one week post natal age .
7- Imaging studies using CUS at 1,3 ,7 days of life and on
discharge . CT scan in neonates suffered from instrumental
delivery , at one week post natal age .
The results of this study revealed that :
• Increased incidence of ICH with lower GA , birth weight and Apgar score.
• The percentage of male with ICH were 42.9% while in female was 21.1% .
• Higher rate of ICH in cases delivered by normal vaginal delivery (44.1%) than those delivered by cesarean section (17.3%).
• Out of 120 neonates 39 neonates developed ICH (32.5 % ).
• IVH was the commonest one 24.2 % , other types are less common, SAH was 2.5 % , SDH was 2.5 % , IPH was 3.3% .
• The majority of cases of IVH were grad I representing 13.4 % , 4. 2% was grad II 3.3 %was grade III , 3.3 %was grad IV .
• There are certain maternal risk factors that are associated with increase risk of ICH , in which prolonged delivery assisted by forceps and vacuum extraction was 43.58 % , 15.38 % was PROM , 12.83 %was mal presentation other risk factors were less common .
• There are certain neonatal risk factors that are associated with increase risk of ICH where in cases with ICH prematurity representing 67.4 % ,76.9 % pneumothorax ,58.8 % trauma ,62.3 % non vertex presentation and 56.4% ventilatory used , all were higher in comparison to cases without ICH .The mean of SBP was 51.23,mean of DBP was 33.72 lower than that of the cases without ICH , mean of CO2 was 61.85 increased than in cases without ICH
• The prevalence of asymptomatic cases with ICH was 66.7 % higher than cases with neurological signs (33.3% ) .
• Neurolgical manifestation among cases with ICH were 66.7 % alert , normal reflexes normotonia .20.5 % irritable,10.3 %lethargic , 2.5 % comatosed , 23.0% with weak suckling ,25.6 %weak moro reflex, 10.3 % absent suckling , 7.7 %absent Moro reflex ,28.2 % were hypotonic , 5.1 % flaccid , 23.2 %were convulsed .
• The need for ventilatory support among cases with ICH was 56.4 % with longer duration of ventilation and lower O2 saturation in comparison to cases without ICH .
• Complication of ventilation in the form of pneumothorax was 76.9 % observed in cases with ICH in comparison to 23.1 %in cases without ICH . The mean of CO2 was 61.85 increased in comparison to 37.21 of cases without ICH .
• There was a significant negative correlation between birth weight ,GA and ICH .
• There were a significant negative correlation between cases with ICH and PH , PO2 , HCO3 , while with PCO2 showed significant positive correlation .
• The most predictor factors for ICH were obstetric risk factors and GA. In which The risk of ICH was nearly 6 folds in group with obstetric risk factors compared to those without obstetric risk factors, Hazard ratio was 6.11, 95%CI (2.12 to 17.6) P=0.001 and 5folds for GA less than 34 weeks than those > 34 weeks GA ,Hazard ratio was 5.06 , 95%CI ( 1.82 to 14.08 ) ( P=0.002) .
• It was found that 41.03 % of cases of ICH appeared by CUS in the first day of life , 76.9 % on third day , 84.6 % at one week post natal age , while 15.6 % of cases of ICH not appeared by CUS and were appeared by CT (extra axial hemorrhage ) .
• The sensitivity of CUS for detection of ICH was 84.6% , the specificity of CUS was higher representing 97.5 % and positive predictive value of CUS for detection of ICH was 94.3 % .
• on discharge it was found that 80.8 % of cases of ICH were resolved on CUS , 19.2 % of cases showed changes of squeals .
• The percentage of neonates exposed to traumatic delivery suffered from ICH (SAH , SDH , IPH )were 58.8% , which diagnosed by CT .
• The mortality rate of total neonates was 20.8% . 33.3% among cases with ICH , in which the higher mortality rate (37.9 % ) was found in cases with IVH and 50% in IPH .
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