Which statement is true about subarachnoid hemorrhage in the premature neonate?

• A. Typically presents with lethargy and poor feeding
• B. Often described as 'well baby with seizures'
• C. Always presents with a bulging fontanelle
• D. Never associated with seizures

Answer: (B)

Subarachnoid hemorrhage in premature neonates is often signaled by seizures, even when the baby otherwise looks well. In preterm infants, fragile vessels in the germinal matrix and related areas are prone to rupture, and irritation of the brain by blood in the subarachnoid space frequently triggers seizure activity. Because the infant may appear clinically stable between events, the description “well baby with seizures” captures a common and important presentation.

Lethargy and poor feeding can occur, but they are nonspecific and less distinctive for SAH in this population. A bulging fontanelle suggests increased intracranial pressure but is not a universal finding in neonatal SAH. And SAH can certainly be associated with seizures, so saying seizures never occur contradicts how these cases typically present.