探讨新生儿中重度（Ⅲ~Ⅳ级）颅内出血（ICH）的临床特征、颅脑超声影像学特征及演变，旨在为临床诊疗及预后评估提供科学依据。

回顾性收集2023年1月至2025年8月期间苏州市立医院经颅脑超声确诊为Ⅲ级或Ⅳ级ICH的64例患儿临床资料，包括围产期基础数据、颅脑超声影像特征及临床转归，根据出院时转归情况，将患儿分为良好结局组和不良结局组，分析患儿不良预后的危险因素。采用 χ²检验比较良好结局组与不良结局组临床资料的差异，采用多因素二元Logistic回归分析ICH患儿不良预后的独立影响因素。

纳入的64例中重度ICH患儿中，出生孕周≤28周的患儿39例（60.9%），出生体质量＜1500 g的患儿43例（67.2%）。首次颅脑超声确诊时，Ⅲ级ICH患儿43例（67.2%，43/64），Ⅳ级ICH患儿21例（32.8%，21/64）。随访过程中，36例（56.3%，36/64）患儿出现脑室进行性扩张（脑积水）；18例（28.1%，18/64）患儿出现脑室周围白质软化（PVL）。不良结局组患儿40例（62.5%，40/64），良好结局组患儿24例（37.5%，24/64），不良结局组Ⅳ级出血患儿比例和PVL检出率均高于良好结局组（40.0% vs 20.8%；37.5% vs 12.5%），差异具有统计学意义（χ²=4.021，P=0.046；χ²=5.21，P=0.015）。多因素Logistic回归进一步分析，排除混杂因素干扰，提示极低出生体质量是ICH患儿发生不良预后的独立危险因素（OR=4.37，95%CI：1.47~12.99，P=0.018）。

中重度ICH患儿预后较差，不良结局率高，Ⅳ级出血、PVL形成及极低出生体质量与不良预后密切相关。颅脑超声可准确诊断早期ICH情况，动态监测病情演变，为指导临床方案制定、改善患儿预后提供可靠依据。

To investigate the clinical and cranial ultrasound (CUS) characteristics of moderate-to-severe (Grade Ⅲ–Ⅳ) neonatal intracranial hemorrhage (ICH), with the aim of providing a scientific basis for clinical diagnosis, treatment, and prognostic evaluation.

We retrospectively collected clinical data from 64 neonates diagnosed with Grade Ⅲ or Ⅳ ICH by cranial ultrasound at Suzhou Municipal Hospital between January 2023 and August 2025. The data included perinatal baseline characteristics, CUS imaging features, and clinical outcomes. Based on outcomes at discharge, patients were divided into a good outcome group and a poor outcome group to analyze risk factors for adverse prognosis. The χ² test was used to compare differences in clinical characteristics between the two groups, and multivariate binary logistic regression analysis was performed to identify independent factors associated with poor prognosis in neonates with ICH.

Among the 64 included neonates with moderate-to-severe ICH, 39 (60.9%) had a gestational age of ≤ 28 weeks, and 43 (67.2%) had a birth weight of ＜1500 g. At the initial CUS diagnosis, 43 cases (67.2%, 43/64) had Grade III ICH and 21 (32.8%, 21/64) had Grade IV ICH. During follow-up, 36 infants (56.3%, 36/64) developed progressive ventricular dilation (hydrocephalus), and 18 (28.1%, 18/64) developed periventricular leukomalacia (PVL). The poor outcome group comprised 40 cases (62.5%, 40/64), while the good outcome group comprised 24 cases (37.5%, 24/64). The rates of Grade Ⅳ hemorrhage and PVL were significantly higher in the poor outcome group than in the good outcome group (χ²=4.021 and 5.21, respectively; both P＜0.05). Multivariate logistic regression analysis, after adjustment for confounding factors, indicated that very low birth weight (VLBW) was an independent risk factor for poor prognosis (OR=4.37, 95%CI: 1.47-12.99, P＜0.05).

Neonates with moderate-to-severe ICH have a poor prognosis with a high rate of adverse outcomes. Grade IV hemorrhage, PVL formation, and VLBW are closely associated with poor prognosis. Cranial ultrasound can accurately diagnose early intracranial hemorrhage and dynamically monitor disease evolution, providing imaging evidence to guide clinical treatment plans and improve patient outcomes.