Study: Autism Risk for Developing Children Exposed to Air Pollution

This study discusses a possible link between exposure to air pollution during pregnancy or while an infant and the development of autism in the child. Is this another epigenetic factor? JR

Research conducted by University of Southern California (USC) and Children's Hospital Los Angeles scientists demonstrates that polluted air -- whether regional pollution or coming from local traffic sources -- is associated with autism.

The study titled "Traffic Related Air Pollution, Particulate Matter, and Autism," shows that exposure to traffic-related air pollution during pregnancy and the first year of life is associated with a more than two-fold risk of autism. In addition, exposure to regional pollution consisting of nitrogen dioxide (NO₂) and small particles -- particulate matter less than 2.5 and 10 microns in diameter (PM2.5 and PM10) -- is also associated with autism even if the mother did not live near a busy road. The study is published in theArchives of General Psychiatry, a sister publication of the Journal of the American Medical Association.

"This work has broad potential public health implications," said the study's principal investigator, Heather Volk, Ph.D., assistant professor of preventive medicine at the Keck School of Medicine of USC and investigator in the Division of Research on Children, Youth and Families at Keck School-affiliated Children's Hospital Los Angeles. "We've known for a long time that air pollution is bad for our lungs, and especially for children. We're now beginning to understand how air pollution may affect the brain."

The research is the first to look at the amount of near-roadway traffic pollution individuals were exposed to and combine that with measures of regional air quality. The study builds on previous research by Volk and colleagues that examined how close subjects lived to a freeway, said Volk, who also has appointments at the Keck School's Zilkha Neurogenetic Institute and Department of Pediatrics.

"We took into account how far away people lived from roads, meteorology such as which way the wind was blowing, how busy the road was, and other factors to study traffic-related pollution," she said. "We also examined data from air quality monitors, which measure pollution over a larger region that could come from traffic, industry, rail yards, or many other sources."

In the 2012 study, Volk and colleagues from USC and the University of California, Davis examined data on 279 autism cases and 245 control subjects enrolled in the California-based Childhood Autism Risks from Genetics and the Environment (CHARGE) study. Mothers' addresses from birth certificates and addresses reported from a residential history were used to estimate exposure during each trimester of pregnancy and the first year of life. The researchers used air pollution levels derived from the Environmental Protection Agency's Air Quality System to determine exposure to NO2, PM2.5, and PM10. They also applied dispersion models to estimate the amount of traffic the mothers and children were exposed to.

Particularly interesting was the effect of mothers' and children's exposure to particles, both PM10 and PM2.5. PM10 includes both coarse and fine particles, while PM2.5 includes only the smaller (fine) particles, which are most likely to have deleterious effects on the human body.

"From studies conducted in the lab, we know that we can breathe in tiny particles and they can produce inflammation," said Volk. "Particles have varied composition, and there are many chemicals that can bind to them. The components of these particles could be hazardous to the brain."

Other researchers who participated in the study include Irva Hertz-Picciotto, University of California, Davis; Rob McConnell from USC; and Fred Lurmann and Bryan Penfold from Sonoma Technology, Inc.

The research was funded by the National Institute of Environmental Health Sciences (grant 1 R21 ES019002-01).

Volk and colleagues are now at work on a study of how genes related to autism may be affected by environmental exposures to try to identify if there are factors that make people are genetically more vulnerable to particular pollutants.

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Benefits of hypothermia for infants continue through early childhood

NIH study shows increased survival from treatment for oxygen deficiency at birth.  I have set up these protocols.   The data is clear that  The treatment  works  and  and I have seen remarkable outcomes.   The protocols need to involve neurology because of the high risk of  subtle seizures and the need for cervical examinations by expert.  One needs to ask if this is a standard of care in 2012.  JR

Benefits of hypothermia for infants continue through early childhood

A treatment to reduce the body temperatures of infants who experience oxygen deficiency at birth has benefits into early childhood, according to a follow-up study by a National Institutes of Health research network.

Children who received the hypothermia treatment as infants were more likely to have survived to ages 6 and 7, when they were evaluated again, than were children who received routine care, the study found. They were no more likely than the routine care group to experience a physical or cognitive impairment, it said. The report appears in the New England Journal of Medicine.

“The findings show that the use of this cooling technique after birth increases the chances of survival, without increasing the risk of long-term disability,” said senior author Rosemary D. Higgins, M.D., of the Pregnancy and Perinatology Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

The study was conducted by Seetha Shankaran, M.D., of Wayne State University in Detroit, Dr. Higgins, and 25 other researchers in the NICHD Neonatal Research Network. In addition to NICHD, funding was also provided by the NIH's National Center for Research Resources and the National Center for Advancing Translational Sciences.

Infants born at term may fail to get enough oxygen, from blood loss or other birth complications. Oxygen deprivation during the birth process is called hypoxic-ischemic encephalopathy, or HIE. In severe cases of HIE, death rates can reach 50 percent. Survivors often sustain brain damage, which can result in cerebral palsy, cognitive impairment, or hearing and vision loss. Even if they do not experience detectable brain damage, children who experience HIE at birth are at higher risk for learning disabilities, language delays, and memory deficits. Severe oxygen deficiency at birth is also known as birth asphyxia.

The current study was in follow up to an earlier study, conducted when the children were newborns and had received the body cooling treatment shortly after birth. That earlier study found that infants who received the cooling treatment were less likely to die or to develop moderate or severe disability than were the infants who received routine care. The original study assessed children's movement and cognitive abilities, hearing, and vision when they were 18 to 22 months old.

The study authors noted that neonatal intensive care units around the world have adopted this cooling technique to reduce the risk of death and disability among full-term infants who show signs of the brain dysfunction indicating oxygen deficiency.

“Testing at 18 months can identify major delays in a toddler's growth or brain development, but can't identify some of the more subtle cognitive or physical impairments that might become apparent in an older child,” Dr. Higgins said. “This follow-up study confirms the original finding, showing that children who received the cooling treatment were more likely to survive, and that the survivors were no more likely to have a disability than the children in the untreated group.”

The 208 children in the study were diagnosed with HIE within 6 hours of birth and treated in newborn intensive care units in the network. They were given the usual intensive care or treated with the body cooling technique. With this technique, cool water circulates inside a waterproof blanket beneath the infant. The cool water reduces the infant's temperature as low as 91.4 degrees Fahrenheit, and maintains it there 72 hours, after which caregivers allow the infant's body temperature to return to a normal.

To conduct the current study, the researchers analyzed data from follow-up visits conducted when these infants had turned 6 or 7 years old. The researchers compared rates of death and disability among those who got the cooling therapy and those who had received the usual intensive care. Mortality rates reflected the number of children who died between birth and age 7. The study found a 28 percent mortality rate in the hypothermia group, compared with 44 percent rate in the usual care group.

The researchers calculated the number of deaths and cases of severe disability as a single combined outcome. In the cooling group, the combined rate was 41 percent, compared with 60 percent in the usual care group. Severe disability involved motor function, cognitive ability, and vision. Rates of cerebral palsy, blindness, and epilepsy were similar between the two groups.

“Before the advent of this cooling treatment in 2005, doctors couldn't treat HIE

Brain Scan Can Detect Early Signs of Autism in Infants

A new study shows significant differences in brain development in high-risk infants who develop autism starting as early as age 6 months. The findings published in the American Journal of Psychiatry reveal that this abnormal brain development may be detected before the appearance of autism symptoms in an infant's first year of life. Autism is typically diagnosed around the age of 2 or 3.

The study offers new clues for early diagnosis, which is key, as research suggests that the symptoms of autism -- problems with communication, social interaction and behavior -- can improve with early intervention. "For the first time, we have an encouraging finding that enables the possibility of developing autism risk biomarkers prior to the appearance of symptoms, and in advance of our current ability to diagnose autism," says co-investigator Dr. Alan Evans at the Montreal Neurological Institute and Hospital -- the Neuro, McGill University, which is the Data Coordinating Centre for the study.

"Infancy is a time when the brain is being organized and connections are developing rapidly," says Dr. Evans. "Our international research team was able to detect differences in the wiring by six months of age in those children who went on to develop autism. The difference between high-risk infants that developed autism and those that did not was specifically in white matter tract development -- fibre pathways that connect brain regions." The study followed 92 infants from 6 months to age 2. All were considered at high-risk for autism, as they had older siblings with the developmental disorder. Each infant had a special type of MRI scan, known as diffusion tensor imaging, at 6 months and a behavioral assessment at 24 months. The majority also had additional scans at either or both 12 and 24 months.

At 24 months, 30% of infants in the study were diagnosed with autism. White matter tract development for 12 of the 15 tracts examined differed significantly between the infants that developed autism and those who did not. Researchers evaluated fractional anisotropy (FA), a measure of white matter organization based on the movement of water through tissue. Differences in FA values were greatest at 6 and 24 months. Early in the study, infants who developed autism showed elevated FA values along these tracts, which decreased over time, so that by 24 months autistic infants had lower FA values than infants without autism.

The study characterizes the dynamic age-related brain and behavior changes underlying autism -- vital for developing tools to aid autistic children and their families. This is the latest finding from the on-going Infant Brain Imaging Study (IBIS), which is funded by the National Institutes of Health (NIH) and brings together the expertise of a network of researchers from institutes across North America. The IBIS study is headquartered at the University of North Carolina, and The Neuro is the Data Coordinating Centre where all IBIS data is centralized.

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Prepregnancy Obesity Linked to Child's Cognitive Function

Women who are obese before they become pregnant are at higher risk of having children with lower cognitive function -- as measured by math and reading tests taken between ages 5 to 7 years -- than are mothers with a healthy prepregnancy weight, new research suggests.

In this large observational study, prepregnancy obesity was associated, on average, with a three-point drop in reading scores and a two-point reduction in math scores on a commonly used test of children's cognitive function.

Previous research has suggested that a woman's prepregnancy obesity can have a negative effect on fetal organs, such as the heart, liver and pancreas. Because fetal development is rapid and sensitive to a mother's physiological characteristics, Ohio State University researchers sought to find out whether a mother's obesity also could affect the fetal brain.

"One way you measure the effects on the brain is by measuring cognition," said Rika Tanda, lead author of the study and a doctoral candidate in nursing at Ohio State.

The research also supported findings in previous studies suggesting that several other conditions affect childhood cognition, including how stimulating the home environment is, family income and a mother's education and cognitive skills.

"The new piece here is we have a measure associated with the fetus's environment to add to that set of potential risk factors," said Pamela Salsberry, senior author of the study and a professor of nursing at Ohio State. "If we have a good way to understand the risks each child is born with, we could tailor the post-birth environment in such a way that they could reach their maximum capabilities."

The research appears online and is scheduled for future print publication in the Maternal and Child Health Journal.

The researchers used data from the National Longitudinal Survey of Youth (NLSY) 1979 Mother and Child Survey, a nationally representative sample of men and women who were 14-21 years old in December 1978. From that dataset, Tanda collected information on 3,412 children born to NLSY mothers who had been full-term births, were between 5 and almost 7 years old at the time of their interview and who had no diagnosed physical or cognition problems.

In addition to documenting a number of characteristics about the mothers and the family environment, the researchers gauged the children's cognitive function based on their performance on Peabody Individual Achievement Test reading recognition and math assessments.

The researchers calculated the mothers' body mass index (BMI) based on their reported heights and weights. More than half of mothers had normal BMIs before pregnancy, and 9.6 percent were obese, meaning they had a BMI of 30 or higher.

Controlling for all other variables, the analysis showed that maternal prepregnancy obesity was negatively associated with math and reading test scores. Children of obese women scored, on average, three points lower on reading and two points lower on math than did children of healthy-weight women. The mean reading score among all the children was 106.1 points and the mean math score was 99.9.

Though the score differences seem small, Tanda noted that these effects of prepregnancy obesity were equivalent to a seven-year decrease in the mothers' education and significantly lower family income, two other known risk factors that negatively affect childhood cognitive function.

Tanda said clinicians could use these findings to help encourage women patients of childbearing age to maintain a healthy weight, especially if they plan to get pregnant.

"This is a large population study, so at the individual level we can't say that one person's decision to change her weight will change her child's outcome," she said. "But these findings suggest that children born to women who are obese before pregnancy might need extra support."

Added Salsberry, "It's not only for their child's sake. It's also important for the health of the mother. But it is important to understand that maternal obesity during pregnancy could have implications for their children as well."

Without actual measures of women's and fetuses' insulin levels, inflammation and blood sugar readings, scientists can't say for sure how prepregnancy obesity might affect the fetal brain. But previous studies have suggested that a mother's impaired metabolic processes affect the fetal brain cell growth and formation of synapses.

The researchers also noted that obesity doesn't automatically equate to unhealthy.

"There may be two obese moms that in fact have very different metabolic profiles. For the purposes of this study, her weight is a stand-in for biological data that we would like to have but don't," Salsberry said.

Socioeconomic data from the study supported previous findings that several post-birth conditions can have a positive association with higher children's test scores. These include a stimulating home environment with plenty of books, a safe play environment and frequent family meals; higher family income; and higher maternal education levels and cognitive function. Girls and first-born children also performed better on the math and reading tests than did boys and younger siblings.

With all these data combined, Tanda said, the study also reveals how health disparities can have long-lasting effects.

"Young females who grow up poor, who have less access to healthy foods resulting in diets that are of poorer quality, are at higher risk of having children with disadvantages and repeating this cycle," she said.

The researchers are continuing to examine additional influences on childhood cognition, including race, sex and age differences among mothers.

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Link Between Autism and Epilepsy

Early-life seizures are known to be associated with autism, and studies indicate that about 40 percent of patients with autism also have epilepsy. A study from Boston Children's Hospital finds a reason for the link, and suggests that an existing drug, already shown to be safe in children, could help prevent autism from developing in newborns who have seizures.

Led by Frances Jensen, MD, in the Department of Neurology and the F.M. Kirby Neurobiology Center at Boston Children's Hospital, the study suggests that seizures over-activate a biochemical pathway previously linked to autism, known as the mTOR pathway, and that this alters the fast-forming circuitry in infants' developing brains.

In a rat model, Jensen and colleagues showed that early seizures not only resulted in epilepsy later in life, but also produced autistic-like behavior. They further showed that disabling the mTOR pathway – by giving the drug rapamycin before and after seizures – prevented development of abnormal patterns of connections (synapses) between brain cells, reduced later-life seizures and eased autistic-like symptoms.

Findings were published May 2 in the online journal PLoS ONE.

"In children, there is overlap between epilepsy and autism, and epilepsy early in life has been linked to later autism," says Jensen of Boston Children's Hospital. "Our findings show one of probably many pathways that are involved in this overlap – importantly, one that is already a therapeutic target and where treatment can reverse the later outcome."

Specifically, the study demonstrated that a group of signaling molecules, known collectively as the mTOR pathway, shows increased activation after a seizure. This increased signaling – above and beyond the surge that normally occurs early in life – disrupted the normal balance of synapse and circuit development to produce epilepsy and altered social behavior. Rapamycin treatment inhibited mTOR signaling, reducing susceptibility to seizures and preventing seizure-induced changes in the synapses.

The study uncovers a new link whereby epilepsy and autism may interact in early development. Last December, Jensen and colleagues published a related study finding that seizures exaggerated excitation and synaptic strengthening too soon in a rat model, causing synapses to lose their plasticity -- their ability to reconfigure in response to input from the outside world. When they gave the rats a drug called NBQX, which blocks receptors associated with excitation, these problems were reversed.

The mTOR pathway is already known to be over-active in tuberous sclerosis complex (TSC) a genetic disorder treated at Boston Children's that often includes epilepsy and autism. The hospital is currently conducting a clinical trial of rapamycin in children with TSC.

"Our study suggests that even without tuberous sclerosis, seizures are inducing the mTOR pathway, and might on their own be contributing to the development of autism," says Jensen. "It appears that blocking the mTOR pathway briefly after the initial seizures may reduce the risk of later epilepsy and autism. This research also suggests that the fields of epilepsy and autism may inform each other about new treatment targets."

For further background, see this feature published last year in Nature Medicine.

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Women Who Smoke during Pregnancy are Likely to Have Child With High Functioning Autism

Women who smoke in pregnancy may be more likely to have a child with high-functioning autism, such as Asperger's Disorder, according to preliminary findings from a study by researchers involved in the U.S. autism surveillance program of the Centers for Disease Control and Prevention.

"It has long been known that autism is an umbrella term for a wide range of disorders that impair social and communication skills," says Amy Kalkbrenner, assistant professor in the University of Wisconsin-Milwaukee's Joseph J. Zilber School of Public Health, lead author of the study. "What we are seeing is that some disorders on the autism spectrum, more than others, may be influenced by a factor such as whether a mother smokes during pregnancy."

The study was published April 25 online by the journal Environmental Health Perspectives.

Smoking during pregnancy is still common in the U.S. despite its known harmful impacts on babies. Kalkbrenner found that 13 percent of mothers whose children were included in the study had smoked during pregnancy.

Kalkbrenner and colleagues' population-based study compared smoking data from birth certificates of thousands of children from 11 states to a database of children diagnosed with autism maintained by the CDC's Autism and Developmental Disabilities Monitoring Network (ADDMN). Of the 633,989 children, born in 1992, 1994, 1996 and 1998, 3,315 were identified as having an autism spectrum disorder at age 8.

"The study doesn't say for certain that smoking is a risk factor for autism," Kalkbrenner says. "But it does say that if there is an association, it's between smoking and certain types of autism," implicating the disorders on the autism spectrum that are less severe and allow children to function at a higher level. That connection, she adds, needs further study.

April is Autism Awareness Month, and several studies of possible links between environmental factors and autism are being published by Environmental Health Perspectives at the same time as Kalkbrenner's study. "The CDC recently released data indicating that 1 in 88 children has an autism spectrum disorder, making such environmental studies even more timely," says Kalkbrenner.

Because autism involves a broad spectrum of conditions and the interplay of genetics and environment is so complex, no one study can explain all the causes of autism, she adds. "The goal of this work is to help provide a piece of the puzzle. And in this we were successful."

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Study Claims Depressed Moms Disturb Their Babies' Sleep

A mother's depression may affect her baby's sleep, a new study suggests.

The results show depressed mothers are more likely to needlessly wake up their infants at night than mothers who are not depressed, the researchers said.

"When depressed mothers sought out their infants at night, their infants did not appear to be in need of parental help. They were either sound asleep or perhaps awake, but not distressed," said study researcher Douglas Teti, professor of human development, psychology, and pediatrics at the Pennsylvania State University.

Depressed mothers who worry excessively about their babies' well-being at night may respond to infant sounds that don't necessarily require response, or move their babies into their own beds to alleviate their own anxieties about whether their infants are hungry, thirsty and comfortable, the researchers said. Mothers who are feeling depressed also may seek out their infants at night for their own emotional comfort, they said.

"Sleep problems often endure beyond early childhood, and can have a negative effect on various aspects of development, including emotional, behavioral, and academic functioning," Teti said. "Understanding how maternal depression and sleep problems combine to affect children's development is important to developing interventions to help reduce these negative consequences."

Teti and colleagues collected data on 45 infants, ages 1 month to 2 years old, and their parents over seven consecutive days. The mothers kept a diary of their infants' sleeping habits, and they also completed a survey to assess their depressive symptoms and worries about their infants.

On the sixth day of the study, the researchers set up video cameras around each baby's bed, and other rooms in the house where mothers took their babies during the night. The cameras captured between 10 and 12 hours of video. What the researchers observed on the videos agreed with what the parents reported.

Mothers with higher levels of depression and more worries about their children's sleep had children whose sleep was more disrupted.

Previous studies had found a link between depression in moms and disturbed sleep in babies, and some researchers had suggested that infants' who slept poorly could affect their mothers' mental health. But the new study shows that it was most likely the mothers' behavior, and not the infants, that played the larger role in the link, the researchers said.

Moms with more symptoms of depression and worries behaved in ways that disrupted their infants' sleep — for example, picking up babies who were sleeping.

If parental depression or worry disrupts both a parent's and an infant's sleep, it could have negative consequences for the parent-child relationship over the long term. In situations like these, steps might be considered to help reduce parents' distress, the researchers wrote in the April 17 issue of the journal Child Development.

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Autistic Kids Born Preterm or Post-Term Have More Severe Symptoms

For children with autism, being born several weeks early or several weeks late tends to increase the severity of their symptoms, according to new research out of Michigan State University.

Additionally, autistic children who were born either preterm or post-term are more likely to self-injure themselves compared with autistic children born on time, revealed the study by Tammy Movsas of MSU's Department of Epidemiology.

Though the study did not uncover why there is an increase in autistic symptoms, the reasons may be tied to some of the underlying causes of why a child is born preterm (prior to 37 weeks) or post-term (after 42 weeks) in the first place.

The research appears online in theJournal of Autism and Development Disorders.

Movsas, a postdoctoral epidemiology fellow in MSU's College of Human Medicine, said the study reveals there are many different manifestations of autism spectrum disorder, a collection of developmental disorders including both autism and Asperger syndrome. It also shows the length of the mother's pregnancy is one factor affecting the severity of the disorder.

While previous research has linked premature birth to higher rates of autism, this is one of the first studies to look at the severity of the disease among autistic children who had been born early, on time and late.

"We think about autism being caused by a combination of genetic and environmental factors," she said. "With preterm and post-term babies, there is something underlying that is altering the genetic expression of autism.

"The outside environment in which a preterm baby continues to mature is very different than the environment that the baby would have experienced in utero. This change in environment may be part of the reason why there is a difference in autistic severity in this set of infants."

Movsas added that for post-term babies, the longer exposure to hormones while a baby is in utero, the higher chance of placental malfunction and the increased rate of C-section and instrument-assisted births may play a role.

The study also found that babies born outside of normal gestational age (40 weeks) -- specifically very preterm babies -- showed an increase in stereotypical autistic mannerisms.

"Normal gestation age of birth seems to mitigate the severity of autism spectrum disorder symptoms, and the types of autistic traits tend to be different depending on age at birth," she said.

The study analyzed an online database compiled by Kennedy Krieger Institute at Johns Hopkins University of nearly 4,200 mothers -- with autistic children ages 4-21 -- between 2006 and 2010. It divided the data on births into four categories: very preterm (born prior to 34 weeks); preterm (34 to 37 weeks); standard (37 to 42 weeks); and post-term (born after 42 weeks)

The mothers filled out a pair of questionnaires regarding the symptoms of their autistic children, and the results revealed very preterm, preterm and post-term autistic children had significantly higher screening scores for autism spectrum disorder than autistic children born full term.

"The findings point to the fact that although autism has a strong genetic component, something about pregnancy or the perinatal period may affect how autism manifests," said Nigel Paneth, an MSU epidemiologist who worked with Movsas on the paper. "This adds to our earlier finding that prematurity is a major risk factor for autism spectrum disorder and may help us understand if anything can be done during early life to prevent or alleviate autism spectrum disorder."

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Did you know that one quarter of babies born by normal vaginal birth will have an asymptomatic brain hemorrhage?

Intracranial Hemorrhage in Asymptomatic Neonates: Prevalence on MR Images and Relationship to Obstetric and Neonatal Risk Factors1

Christopher B. Looney, BS, J. Keith Smith, MD, PhD, Lisa H. Merck, MD, MPH, Honor M. Wolfe, MD, Nancy C. Chescheir, MD, Robert M. Hamer, PhD and John H. Gilmore, MD

+ Author Affiliations

1From the Department of Psychiatry, CB No. 7160, 7025A Neurosciences Hospital, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7160. From the 2005 RSNA Annual Meeting. Received January 23, 2006; revision requested March 23; revision received June 7; accepted June 21; final version accepted August 21. J.H.G. supported by National Institute of Mental Health grant 1 P50 MH064065. C.B.L. supported by a Distinguished Medical Scholarship from UNC School of Medicine.

Address correspondence to

J.H.G. (e-mail: jgilmore@med.unc.edu).

Next SectionAbstract

Purpose: To retrospectively evaluate the prevalence of neonatal intracranial hemorrhage (ICH) and its relationship to obstetric and neonatal risk factors.

Materials and Methods: Pregnant women were recruited for a prospective study of neonatal brain development; the study was approved by the institutional review board and complied with HIPAA regulations. After informed consent was obtained from a parent, neonates were imaged with 3.0-T magnetic resonance (MR) imaging without sedation. The images were reviewed by a neuroradiologist with 12 years of experience for the presence of ICH. Medical records were prospectively and retrospectively reviewed for selected risk factors, which included method of delivery, duration of labor, and evidence of maternal or neonatal birth trauma. Risk factors were assessed for relationship to ICH by using Fisher exact test statistics.

Results: Ninety-seven neonates (mean age at MR imaging, 20.8 days ± 6.9 [standard deviation]) underwent MR imaging between the ages of 1 and 5 weeks. Eighty-eight (44 male and 44 female) neonates (65 with vaginal delivery and 23 with cesarean delivery) completed the MR imaging evaluation. Seventeen neonates with ICHs (16 subdural, two subarachnoid, and six parenchymal hemorrhages) were identified. Seven infants had two or more types of hemorrhages. All neonates with ICH were delivered vaginally, with a prevalence of 26% in vaginal births. ICH was significantly associated with vaginal birth (P < .005) but not with prolonged duration of labor or with traumatic or assisted vaginal birth.

Conclusion: Asymptomatic ICH following vaginal birth in full-term neonates appears to be common, with a prevalence of 26% in this study.


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