Neonatal Med.  2024 Feb;31(1):9-15. 10.5385/nm.2024.31.1.9.

Full-Term Baby with Cerebellar Hemorrhage Referred for Severe Jaundice Occurring within the First 3 Days of Life

• Lee IW
• Hwang JK
• Ahn JH
• Lee HJ
• Kim CR

• KMID: 2553144
• DOI: http://doi.org/10.5385/nm.2024.31.1.9

Abstract

Cerebellar hemorrhage in full-term infants is a rare condition recently recognized in high-risk newborns requiring intensive care with the availability of advanced neuroimaging techniques. Several aspects such as the incidence, pathophysiology, clinical features, and prognosis of cerebellar hemorrhage in full-term infants remain unknown. We present a case of cerebellar hemorrhage with subdural hemorrhage in a patient hospitalized for jaundice after birth without a history of traumatic delivery, such as breech presentation, prolonged labor or forceps delivery. A full-term female infant weighing 3,100 g at birth, with no complications during delivery, developed jaundice within 48 hours of birth and was admitted for intensive phototherapy in the first 3 days of life with a transcutaneous total bilirubin level of 18.1 mg/dL. Magnetic resonance imaging revealed cerebellar brain lesions with a subdural hemorrhage. At the age of 3 months, the infant exhibited leg rigidity and was referred for rehabilitation. The patient showed signs of improvement during treatment and was generally catching up well with her peers at the age of 9 months. Long-term follow-ups are required to evaluate the consequences on cognitive development, behavior, and motor performance subsequently in life.

Keyword

Posterior fossa hemorrhage; Jaundice; Infant, newborn; Birth of full-term newborn; Infant development

Figure

• 

  Figure 1. Subacute cerebellar hemorrhage and subacute subdural hemorrhage (SDH) (12 days after birth). (A-C) Arrows indicate the areas of cerebellar hemorrhage. (D-F) Arrows indicate the areas of subdural hemorrahge. (A) cT1: subacute cerebellar hemorrhagic lesion (CBH) on the left and right sides of the cerebellum. (B) cT2: fluid-attenuated inversion recovery (FLAIR). Subacute CBH is found in the same area. (C) Susceptibility weighted imaging with phase enhancement (SWIp): subacute CBH is found in the same area. Microbleeding is found in the SWIp view. (D) cT1: subacute stage SDH along both T-O and cerebellar convexity. (E) cT2: FLAIR. Subacute SDH lesion is found in the same area. (F) SWIp: subacute SDH lesion is found in the same area.

• 

  Figure 2. Follow-up brain magnetic resonance imaging performed 78 days after birth. (A) cT1: hemorrhagic lesion is not visible in the T1 image. (B) cT2: fluid-attenuated inversion recovery (FLAIR). Focal hemosiderin deposit is found in the same area. (C) Susceptibility weighted imaging with phase enhancement (SWIp): focal hemosiderin deposit at right cerebellum and smaller microbleeds at the cerebellum and the left occipital lobe. (B, C) Arrows indicate the areas of hemosiderin deposit. (D) cT1: resolved subdural hemorrhage (SDH) along both T-O convexity and cerebellar convexity. (E) cT2: FLAIR. Resolved SDH in the same area. (F) SWIp: resolved SDH in the same area.

Reference

1. Steggerda SJ, Leijser LM, Wiggers-de Bruine FT, van der Grond J, Walther FJ, van Wezel-Meijler G. Cerebellar injury in preterm infants: incidence and findings on US and MR images. Radiology. 2009; 252:190–9.

2. Boswinkel V, Steggerda SJ, Fumagalli M, Parodi A, Ramenghi LA, Groenendaal F, et al. The CHOPIn study: a multicenter study on cerebellar hemorrhage and outcome in preterm infants. Cerebellum. 2019; 18:989–98.

3. Pierson CR, Al Sufiani F. Preterm birth and cerebellar neuropathology. Semin Fetal Neonatal Med. 2016; 21:305–11.

4. Bulas DI, Taylor GA, Fitz CR, Revenis ME, Glass P, Ingram JD. Posterior fossa intracranial hemorrhage in infants treated with extracorporeal membrane oxygenation: sonographic findings. AJR Am J Roentgenol. 1991; 156:571–5.

5. Limperopoulos C, Robertson RL, Sullivan NR, Bassan H, du Plessis AJ. Cerebellar injury in term infants: clinical characteristics, magnetic resonance imaging findings, and outcome. Pediatr Neurol. 2009; 41:1–8.

6. Steggerda SJ, de Bruine FT, Smits-Wintjens VE, Verbon P, Walther FJ, van Wezel-Meijler G. Posterior fossa abnormalities in high-risk term infants: comparison of ultrasound and MRI. Eur Radiol. 2015; 25:2575–83.

7. Stolwijk LJ, Keunen K, de Vries LS, Groenendaal F, van der Zee DC, van Herwaarden MY, et al. Neonatal surgery for noncardiac congenital anomalies: neonates at risk of brain injury. J Pediatr. 2017; 182:335–41.

8. Whitby EH, Griffiths PD, Rutter S, Smith MF, Sprigg A, Ohadike P, et al. Frequency and natural history of subdural haemorrhages in babies and relation to obstetric factors. Lancet. 2004; 363:846–51.

9. Biran V, Verney C, Ferriero DM. Perinatal cerebellar injury in human and animal models. Neurol Res Int. 2012; 2012:858929.

10. Anderson NB, Calkins KL. Neonatal indirect hyperbilirubinemia. Neoreviews. 2020; 21:e749–60.

11. Singh J, Dalal P, Bhalla K, Rattan KN. Neonatal adrenal hemorrhage presenting as prolonged hyperbilirubinemia. J Neonatal Surg. 2016; 5:22.

12. Dennery PA, Seidman DS, Stevenson DK. Neonatal hyperbilirubinemia. N Engl J Med. 2001; 344:581–90.

13. Kim C, Choi GY, Son SH, Kim YJ, Shin SH, Lee JM, et al. The clinical characteristics and the neurodevelopmental outcomes of the neonates with cerebellar hemorrhage. Neonatal Med. 2013; 20:113–20.

14. Berg RM, Plovsing RR. Effects of short-term mechanical hyperventilation on cerebral blood flow and dynamic cerebral autoregulation in critically ill patients with sepsis. Scand J Clin Lab Invest. 2016; 76:226–33.

15. Merrill JD, Piecuch RE, Fell SC, Barkovich AJ, Goldstein RB. A new pattern of cerebellar hemorrhages in preterm infants. Pediatrics. 1998; 102:E62.

16. Kidokoro H, Anderson PJ, Doyle LW, Woodward LJ, Neil JJ, Inder TE. Brain injury and altered brain growth in preterm infants: predictors and prognosis. Pediatrics. 2014; 134:e444–53.

17. Ecury-Goossen GM, Dudink J, Lequin M, Feijen-Roon M, Horsch S, Govaert P. The clinical presentation of preterm cerebellar haemorrhage. Eur J Pediatr. 2010; 169:1249–53.

18. Steggerda SJ, van Wezel-Meijler G. Cranial ultrasonography of the immature cerebellum: role and limitations. Semin Fetal Neonatal Med. 2016; 21:295–304.

19. Williamson WD, Percy AK, Fishman MA, Cheek WR, Desmond MM, LaFevers N, et al. Cerebellar hemorrhage in the term neonate: developmental and neurologic outcome. Pediatr Neurol. 1985; 1:356–60.