Intracranial hemorrhage (ICH) in the neonatal period remains a major clinical problem with potentially devastating consequences, depending on the type and severity of hemorrhage. The four major types of ICH are primary subarachnoid (SAH), subdural, intracerebellar, and intraventricular. Subarachnoid hemorrhage, the most common type of ICH in the term infant,1 is classified as primary when the hemorrhage in the subarachnoid space is not due to extension from other sites. Primary SAH is generally regarded as benign, although massive SAH can result in catastrophic deterioration. Factors that predispose to primary SAH include prematurity, vaginal delivery, perinatal trauma, hypoxia, and the need for resuscitation.
It has been proposed that SAH is caused by shearing of the fragile vessels of the leptomeningeal plexus, subpial bleeding, or rupture of bridging veins traversing the subarachnoid space.2 Since such events may occur during prolonged labor or delivery, it is difficult to differentiate symptoms caused