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The term infant is remarkably resistant to bleeding, despite physiologically low levels of procoagulant proteins reflected in prolongation of coagulation screening tests (see article on hemostasis in the neonate in this issue). However, because of their unique hemostatic systems, neonates do suffer hemorrhagic disorders. Neonatal intracranial hemorrhage may result from birth trauma, thrombocytopenia, hereditary bleeding diatheses, vascular malformations, and acquired conditions such as infection. A recent study reported intracranial hemorrhage following spontaneous vaginal delivery at a rate of 1 per 1,900. In comparison, vacuum extracted neonates had an intracranial hemorrhage rate of 1 per 860. Vacuum extraction is very traumatic to fragile neonatal cranial blood vessels. Intracranial hemorrhage is especially common in sick preterm infants, who suffer a generally higher rate of hemorrhage.

The evaluation of bleeding in a neonate demands a different approach than that taken for older children. The...

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