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Intraventricular haemorrhage and its prognosis, prevention and treatment in term infants
1Department of Paediatrics, People's Hospital, Zhumadian City, Henan, China.
Insights
Intraventricular haemorrhage (IVH) in term infants has a variable prognosis, with severity and perinatal alloimmune thrombocytopenia being key factors. Early in-utero detection and treatment are crucial for preventing severe IVH and improving outcomes.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Obstetrics
Background:
- Intraventricular haemorrhage (IVH) is a significant concern in term infants.
- Understanding its prognosis, prevention, and treatment is critical for clinical practice.
Purpose of the Study:
- To investigate the prognosis of intraventricular haemorrhage (IVH) in term infants.
- To explore the prevention and treatment strategies for IVH in this population.
Main Methods:
- Diagnosis of IVH in term newborns using computerized tomography (CT) or cranial ultrasonography (US).
- Grading of haemorrhage severity by an independent radiologist using Papile's criteria.
- Long-term follow-up of survivors with developmental assessments.
Main Results:
- Mortality rate of 8% among infants with IVH.
- Perinatal alloimmune thrombocytopenia identified as a major cause of severe IVH and poor outcomes.
- 22 out of 33 survivors (67%) experienced no or mild handicap, while severe handicaps were noted in survivors of grade IV IVH.
Conclusions:
- The severity of IVH is a significant prognostic indicator.
- Perinatal alloimmune thrombocytopenia is the primary cause of severe IVH and adverse outcomes.
- In-utero identification and management are essential for preventing IVH and its complications.
Abstract:
The purpose of this study was to investigate the prognosis of intraventricular haemorrhage (IVH) in term infants and its prevention and treatment. The authors diagnosed IVH in full-term newborns by using computerized tomography (CT) or cranial ultrasonography (US). The results of CT or US were reviewed and the grade of haemorrhage was determined by an independent radiologist using Papile's criteria. All the infants were examined on the first day of their life by a paediatrician and judged to be full term. Survivors were examined between age 2 and 10 years at the Child Development Clinic by a Developmental Paediatrician using the Gesell scales and a standard neurologic examination. The results showed that three of 36 infants (8 per cent) died; complications of pregnancy were present in 17 mothers (47 per cent); nine women tested negative for platelet antigen 1 and their infants exhibited alloimmune thrombocytopenia. Age at diagnosis ranged from in utero to 28 days. Clinical presentation included feeding intolerance, irritability, jaundice, fever, and restlessness. Of the nine children with grade IV IVH, three died and six survivors were severely handicapped. Overall, 22 (67 per cent) of 33 survivors had no or mild handicap. The results of this study suggest that severity of haemorrhage was of prognostic value. Perinatal alloimmune thrombocytopenia turned out to be the single most important cause of severe haemorrhage and poor outcome. Identification and treatment of these infants must begin in utero if we are to prevent IVH and its complications in this group of patients.