In-Hospital Neonatal Head Injury: A Multicenter Retrospective Cohort Study

OBJECTIVE: In-hospital neonatal head injuries are rare but potentially serious. Information regarding their mechanisms, management, and outcomes during the early postnatal period is limited. PATIENTS AND METHODS: This is an analysis of data collected as part of a multicenter retrospective study on neonatal head trauma between 2017 and 2021, involving 15 Italian maternity units. Patients included were newborns (aged <29 days) who sustained head trauma as a result of an in-hospital fall during routine postnatal hospitalization. Delivery-related injuries were excluded. Neonatal complications and prematurity were not considered as exclusion criteria. Clinical data, imaging, and outcomes were collected. The Pediatric Emergency Care Applied Research Network (PECARN) rule for children <2 years was applied retrospectively to assess the risk of clinically important traumatic brain injury (ciTBI) and to evaluate physician adherence to this prediction rule. RESULTS: Thirty-nine newborns sustained an in-hospital fall, with a median age at injury of 32 hours; 64.1% occurred at night, mainly in rooming-in units. Neuroimaging was performed in 89.7% of cases. Ten neonates (25.6%) had a ciTBI; none required neurosurgery or developed sequelae. The median length of stay after the head injury was 86 hours (IQR, 48–120), significantly longer than standard postnatal hospitalization. Most low-risk patients (88.9%) nonetheless underwent imaging. CONCLUSIONS: In-hospital neonatal head injuries are mostly low-severity events but lead to extensive diagnostic workup and prolonged hospitalization. This study provides novel insight into mechanisms and management patterns, emphasizing the need for targeted prevention strategies and standardized evaluation protocols.