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Updated: Jul 5, 2026
Modeling Neonatal Intraventricular Hemorrhage Through Intraventricular Injection of Hemoglobin
Published on: August 25, 2022
Interdisciplinary surveillance of intraventricular haemorrhage associated conditions in infants <1000 g
Michael Obladen1, Boris Metze, Wolfgang Henrich
1Department of Neonatology, Charité Berlin, Berlin, Germany. michael.obladen@charite.de
Insights
Prospective surveillance of conditions linked to intraventricular haemorrhage (IVH) in premature infants significantly reduced IVH incidence. This collaborative approach by obstetricians and neonatologists demonstrates IVH is preventable.
Area of Science:
- Neonatalogy
- Perinatology
- Pediatric Neurology
Background:
- Intraventricular haemorrhage (IVH) is a severe complication in infants weighing less than 1000 grams.
- Numerous factors contribute to IVH, including incomplete antenatal steroids, acidosis, and hypothermia.
Purpose of the Study:
- To test the hypothesis that prospective surveillance of IVH-associated conditions reduces their frequency and subsequently the incidence of IVH.
- To evaluate the impact of interdisciplinary review conferences on IVH prevention.
Main Methods:
- Prospective monitoring of IVH and associated conditions in infants <1000 g.
- Monthly interdisciplinary review conferences for IVH surveillance.
- Comparison of data with a historical control group from routine monitoring.
Main Results:
- IVH incidence decreased from 29/86 to 12/89 infants during IVH surveillance (p = 0.007).
- Severe IVH (grades 3-4) dropped significantly from 20% to 3.4% (p = 0.0006).
- Improvements noted in antenatal steroid completion and timely surfactant administration.
Conclusions:
- Intraventricular haemorrhage is not an unavoidable outcome for high-risk infants.
- Joint prospective surveillance by obstetricians and neonatologists can effectively reduce IVH incidence.
Aim:
Intraventricular haemorrhage (IVH) causes some of the most adverse outcomes in infants with birthweight <1000 g. Incomplete antenatal steroids, acidosis, inflammation, postnatal transfer, delayed surfactant administration, hypothermia, hypotension, hypocapnia, persistent ductus arteriosus and pneumothorax are all associated with IVH. We hypothesized that prospective surveillance of these IVH-associated conditions decreases their frequency and thus the frequency of IVH.
Methods:
Cranial ultrasound was performed on days 1, 3, 7, 30 after birth and at discharge, and was assessed according to Papile. The incidence of IVH and IVH-associated conditions was monitored prospectively in all infants <1000 g born in our perinatal centre in 2005/2006, and obstetricians and neonatologists held monthly interdisciplinary review conferences to discuss the preventability of IVH-associated conditions (IVH surveillance). These data were compared to existing prospective data gathered during routine monitoring in 2004.
Results:
IVH (all grades) occurred in 29/86 extremely low birthweight (ELBW) infants during routine monitoring and in 12/89 ELBW infants during IVH surveillance (p = 0.007). IVH grades 3-4 dropped from 20% to 3.4% (p = 0.0006). There were significant differences in completeness of antenatal steroids (54% vs. 67%, p = 0.04) and timeliness in initial surfactant substitution (45% vs. 71%, p = 0.01). Most other IVH-associated conditions were reduced during IVH surveillance without reaching significance.
Conclusions:
IVH is not always an inevitable disaster. Obstetricians and neonatologists can reduce its incidence by joint prospective surveillance of IVH-associated conditions.
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