Hyperthermia as an Early Sign of Intracranial Hemorrhage in Full-term Neonates

Shiuh Bin Fang, Ya Ting Chang, Ying Hsiang Chuo, Suei Tsau Tsai, Chao Lin Tseng

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Intracranial hemorrhage (ICH) in full-term infants is uncommon and is a rare cause of neonatal fever. This study was conducted to estimate the incidences of ICH and fever in a hospital-based population, and to determine if the clinical features of neonatal ICH with and without hyperthermia differ. Methods: We selected 315 afebrile neonates who received cranial ultrasonography screening from 2003 to 2004 as the control group, and 153 neonates diagnosed with fever from 1998 to 2004 as the study group. During the same period, 28 full-term neonates with birth weights > 2500 g and ICH in the first week of life were enrolled retrospectively. They were divided into hyperthermia (n = 11) and nonhyperthermia (n = 17) groups. Results: Three babies in the control group and 11 in the study group had ICH; the incidence of ICH in the hyperthermia group was significantly higher (3/315 vs. 11/153; p <0.001). Compared with the nonhyperthermia group, the hyperthermia group had less cyanosis (2/11 vs. 10/17; p = 0.04), less lymphocyte predominance (33.7 vs. 80%; p = 0.032), higher neutrophil/lymphocyte ratio (1.9 vs. 0.3; p = 0.006), higher erythrocyte/leukocyte ratio (425 vs. 79.5; p = 0.05) in cerebrospinal fluid and an increased incidence of subarachnoid hemorrhage accompanied by intracerebral parenchymal hemorrhage (4/11 vs. 0/17; p = 0.016). Conclusion: The incidence of ICH was higher in febrile than in afebrile neonates. ICH presenting with hyperthermia might go unrecognized, because its other symptoms are subtle and a neutrophil predominance in the cerebrospinal fluid might result in a misdiagnosis of meningitis. ICH in the interior brain tended to manifest more commonly as hyperthermia than did ICH in the superficial brain. A cranial image examination should be considered in the evaluation of neonatal fever.

Original languageEnglish
Pages (from-to)71-76
Number of pages6
JournalPediatrics and Neonatology
Volume49
Issue number3
DOIs
Publication statusPublished - Jun 2008
Externally publishedYes

Fingerprint

Intracranial Hemorrhages
Fever
Newborn Infant
Incidence
Cerebrospinal Fluid
Neutrophils
Lymphocytes
Control Groups
Cyanosis
Cerebral Hemorrhage
Brain
Subarachnoid Hemorrhage
Diagnostic Errors
Meningitis
Birth Weight
Ultrasonography
Leukocytes
Erythrocytes

Keywords

  • full-term neonates
  • hyperthermia
  • intracranial hemorrhage

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Hyperthermia as an Early Sign of Intracranial Hemorrhage in Full-term Neonates. / Fang, Shiuh Bin; Chang, Ya Ting; Chuo, Ying Hsiang; Tsai, Suei Tsau; Tseng, Chao Lin.

In: Pediatrics and Neonatology, Vol. 49, No. 3, 06.2008, p. 71-76.

Research output: Contribution to journalArticle

Fang, Shiuh Bin ; Chang, Ya Ting ; Chuo, Ying Hsiang ; Tsai, Suei Tsau ; Tseng, Chao Lin. / Hyperthermia as an Early Sign of Intracranial Hemorrhage in Full-term Neonates. In: Pediatrics and Neonatology. 2008 ; Vol. 49, No. 3. pp. 71-76.
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AU - Tsai, Suei Tsau

AU - Tseng, Chao Lin

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N2 - Background: Intracranial hemorrhage (ICH) in full-term infants is uncommon and is a rare cause of neonatal fever. This study was conducted to estimate the incidences of ICH and fever in a hospital-based population, and to determine if the clinical features of neonatal ICH with and without hyperthermia differ. Methods: We selected 315 afebrile neonates who received cranial ultrasonography screening from 2003 to 2004 as the control group, and 153 neonates diagnosed with fever from 1998 to 2004 as the study group. During the same period, 28 full-term neonates with birth weights > 2500 g and ICH in the first week of life were enrolled retrospectively. They were divided into hyperthermia (n = 11) and nonhyperthermia (n = 17) groups. Results: Three babies in the control group and 11 in the study group had ICH; the incidence of ICH in the hyperthermia group was significantly higher (3/315 vs. 11/153; p <0.001). Compared with the nonhyperthermia group, the hyperthermia group had less cyanosis (2/11 vs. 10/17; p = 0.04), less lymphocyte predominance (33.7 vs. 80%; p = 0.032), higher neutrophil/lymphocyte ratio (1.9 vs. 0.3; p = 0.006), higher erythrocyte/leukocyte ratio (425 vs. 79.5; p = 0.05) in cerebrospinal fluid and an increased incidence of subarachnoid hemorrhage accompanied by intracerebral parenchymal hemorrhage (4/11 vs. 0/17; p = 0.016). Conclusion: The incidence of ICH was higher in febrile than in afebrile neonates. ICH presenting with hyperthermia might go unrecognized, because its other symptoms are subtle and a neutrophil predominance in the cerebrospinal fluid might result in a misdiagnosis of meningitis. ICH in the interior brain tended to manifest more commonly as hyperthermia than did ICH in the superficial brain. A cranial image examination should be considered in the evaluation of neonatal fever.

AB - Background: Intracranial hemorrhage (ICH) in full-term infants is uncommon and is a rare cause of neonatal fever. This study was conducted to estimate the incidences of ICH and fever in a hospital-based population, and to determine if the clinical features of neonatal ICH with and without hyperthermia differ. Methods: We selected 315 afebrile neonates who received cranial ultrasonography screening from 2003 to 2004 as the control group, and 153 neonates diagnosed with fever from 1998 to 2004 as the study group. During the same period, 28 full-term neonates with birth weights > 2500 g and ICH in the first week of life were enrolled retrospectively. They were divided into hyperthermia (n = 11) and nonhyperthermia (n = 17) groups. Results: Three babies in the control group and 11 in the study group had ICH; the incidence of ICH in the hyperthermia group was significantly higher (3/315 vs. 11/153; p <0.001). Compared with the nonhyperthermia group, the hyperthermia group had less cyanosis (2/11 vs. 10/17; p = 0.04), less lymphocyte predominance (33.7 vs. 80%; p = 0.032), higher neutrophil/lymphocyte ratio (1.9 vs. 0.3; p = 0.006), higher erythrocyte/leukocyte ratio (425 vs. 79.5; p = 0.05) in cerebrospinal fluid and an increased incidence of subarachnoid hemorrhage accompanied by intracerebral parenchymal hemorrhage (4/11 vs. 0/17; p = 0.016). Conclusion: The incidence of ICH was higher in febrile than in afebrile neonates. ICH presenting with hyperthermia might go unrecognized, because its other symptoms are subtle and a neutrophil predominance in the cerebrospinal fluid might result in a misdiagnosis of meningitis. ICH in the interior brain tended to manifest more commonly as hyperthermia than did ICH in the superficial brain. A cranial image examination should be considered in the evaluation of neonatal fever.

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