Imaging Patterns of Neonatal Subpial Hemorrhage: Provisional Statements on Neurologic Outcomes
Bibliographic record
Abstract
ABSTRACT BACKGROUND AND PURPOSE: Subpial hemorrhage is an underrecognized type of hemorrhagic stroke primarily affecting neonates. Blood accumulation in the impermeable pia mater compresses the adjacent cortex, leading to injury. The consequences of this stroke type remain poorly understood. The study aims to evaluate the association between imaging findings and neurological outcomes at follow-up in neonates with subpial hemorrhage. MATERIALS AND METHODS: We retrospectively included neonates with suspected subpial hemorrhage who underwent brain MRI between January 2012 and February 2024. Two pediatric neuroradiologists evaluated MRIs for subpial hemorrhage location, size, and pattern using a previously described system that classified subpial hemorrhage only (Pattern A), subpial hemorrhage with cortical injury (Pattern B), and subpial hemorrhage with cortical injury and intraparenchymal hemorrhage (Pattern C). They also assessed for medullary vein engorgement/thrombosis. We extracted demographic data, perinatal events, hospital outcomes, and Alberta Infant Motor Scale (AIMS) scores, when available. Descriptive analysis was used for demographic, clinical, and imaging findings. Fisher9s exact test evaluated associations between clinical outcomes and imaging findings. RESULTS: Twenty-nine patients (median gestational age 38 weeks, IQR: 37-39) were included, with 82% having birthweights >2500g. Subpial hemorrhages were most commonly on the right side (66%) and in the temporal lobe (62%). Most hemorrhages measured 1-4 cm (59%). Pattern C (15/29, 52%) was associated with delayed motor development as assessed by AIMS (9/15, 60%) (p=.042), while Pattern B (10/29, 35%) was associated with near-normal motor development (6/15, 40%) (p=.044). There was no statistically significant association between concurrent superficial and deep medullary vein engorgement/thrombosis and the presence of any neurological deficit (p=.055). CONCLUSIONS: The association between subpial hemorrhage patterns and neurological outcomes, particularly motor development, may have important prognostic and management implications. In our cohort, a pattern C of subpial hemorrhage was significantly associated with delayed motor development. Concurrent involvement of superficial and deep medullary vessels may indicate a higher risk of poor neurological outcomes. These findings highlight the importance of early intervention and monitoring in neonates presenting with subpial hemorrhage. ABBREVIATIONS: AIMS= Alberta Infant Motor Scale; IQR= Interquartile Ranges; NICU= Neonatal Intensive Care Unit; SD= Standard Deviations.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".