Subdural Bleeding in Infants is Proof of Abuse, Right?

By Jim Windell

           In 2000, the American Academy of Pediatrics issued a position paper associating child abuse with subdural hematoma and hemorrhages. Subsequently, it was assumed that when subdural hemorrhages were present, shaken baby syndrome or some other form of caretaker abuse could be implicated.

           In 2007, University of North Carolina researchers published unexpected and surprising results from a study based on magnetic resonance imaging (MRI) of newborn brains. Twenty-six percent of the newborns in the study were found to have asymptomatic subdural hemorrhages, or bleeding in and around the brain. That was an unexpected finding because subdural hemorrhage had been considered unusual in full-term newborns. But the those 2007 findings suggested that small, asymptomatic brain bleeds might be a fairly common consequence of a normal vaginal delivery.

           Now, in 2020, 13 years later, John H. Gilmore, MD, professor and vice chair of research in the University of North Carolina Department of Psychiatry and senior author of the 2007 study, and J. Keith Smith, MD, PhD, vice chair of the UNC Department of Radiology, have published a follow-up study in the journal Radiology.

           In this new study, data was collected from 311 infants between 2003 and 2016 as part of the UNC Early Brain Development Study. Neurodevelopmental outcomes were evaluated at two years of age using the Mullen Scales of Early Learning (MSEL). All of the infants had MRI brain scans and were evaluated for subdural hemorrhage as neonates and at ages one and two years.

           In comparing the children with a history of subdural hemorrhage to those without, the study authors found no differences between the two groups in either MSEL scores or in total gray matter volumes. Furthermore, at age two there was no evidence of rebleeding in the children who had subdural hemorrhages as neonates.

           John Gilmore, the senior author of the research and the director of UNC Center of Excellence in Community Mental Health, says that "Since the bleeds were so common, we believed that they did not have a significant impact on brain development, but had no hard data to know for sure. This follow-up study is reassuring and demonstrates that children with these minor perinatal bleeds have normal cognitive development at two years of age."

           According to J. Keith Smith, there are two really important findings of this work. "These small bleeds, which are very common, do not seem to harm brain development, and they also go away and don't predispose to later bleeding or other abnormalities."

           He might also have added that small subdural bleeds are very common – and do not indicate abuse or accidental mishandling by parents or other caregivers.

           To read the original source of the article, click here.

            To see the journal article, use this information:

Carlos Zamora, Cassandra Sams, Emil A. Cornea, Zhenhua Yuan, J. Keith Smith, & John H. Gilmore. (2020). Subdural Hemorrhage in Asymptomatic Neonates: Neurodevelopmental Outcomes and MRI Findings at 2 Years. Radiology, 201857 DOI: 10.1148/radiol.2020201857