Predictors of intraventicular hemorhage in the neonatal intensive care unit

Abstract

Aim: To analyze intraventricular hemorrhage (IVH) incidence, clinical features and risk factors in extremely low birth weight infants.

Materials and Method(s): It is a single-center, retrospective cohort in infants delivering neonatal intensive care between 2010 and 2019. Infants of birth weight <1000 grams who had transfontanel-ultrasounds in the first week of life were included. Postnatal transfers, central nervous system anomalies, antenatal-diagnosed hemorrhage, death before obtaining transfontanel-ultrasound and incomplete dataset were excluded from the study. Infants were categorized as mild IVHs (grades 1-2), severe IVHs (grade-3, periventricular-hemorrhagic infarct) and control group. Ante-perinatal characteristics, clinical and laboratory features were recorded. SPSS23 program utilized analysis for three groups.

Results: Overall IVH incidence was 22.9% in 455 neonates (52.9%, 49%, 31.5%, 13.4%, 6.7% at =25, 26, 27, 28 and 29 gestational weeks. Seizure was the first sign in 32.7% of the infants. Neonatal resuscitation, umbilical-cord blood pH, chorioamnionitis, patent ductus arteriosus were associated with developing mild IVH, but did not influence the progression to severe hemorrhage (p=0.782, p=0.109, p=0.566, p=0.111). Gestational age, invasive mechanical ventilation, inotrope-required hypotension was related to high-grade IVHs (p<0.001, p=0.025, p=0.013). The predictive strength of platelets to define IVH was poor at intensive care admission (sensitivity: 74%, specificity: 68.3%). Inotrope-required hypotension and low-umbilical-cord blood pH were determined as independent risk factors of high-grade IVHs (OR: 6.678, 95% CI: 2.557-17.443 and OR: 3.554, 95%CI: 1.089-11.602). Four infants necessitated ventriculo-peritoneal shunting. Mortality was 23.1% in infants developing IVH.

Conclusion: Inotrope-required hypotension is the strongest predisposing factor for high-grade ventricular hemorrhage in extremely low birth weight infants.