Study on subdural hemorrhages in newborns can have medico-legal implications
A recent study on subdural hemorrhages in neonates published in the March 13 issue of Lancet ( 2004, Vol. 363, No. 9412) not only gives us more insight into birth trauma, but could also have medical-legal implications.
The study, authored by EH Whitby, PD Griffiths, R Rutter, et. al screened by MRI, 111 asymptomatic newborns within 48 hours after birth to look for subdural hematomas as a result of the birth process. None of them were classified as having had a “difficult” birth. Nine of the 111 newborns (8%) had subdural hematomas. None of them were apparently symptomatic and their neurological exams were normal.
Only forceps-assisted delivery after failed vacuum extraction could be considered a predictor of hematoma. Forceps alone was not associated with hematomas. Three of the children with subdural hemorrhages were born by vaginal delivery without assisted mechanical intervention. All hematomas detected in the study resolved by the 4th week.
This study could have tremendous implications in cases where a child presents in the ER and the parent is accused of abuse. If an MRI is taken within the first 4 weeks, and the child had been asymptomatic at birth, it is possible that instead of assuming the hematoma occurred from abuse, it could have occurred from natural birth trauma.