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Risk factors for intraventricular hemorrhage in very low birth weight infants in Tehran, Iran
Fariba Khodapanahandeh1, Nastaran Khosravi, Tahereh Larijani
1Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran.
Insights
High-grade intraventricular hemorrhage (IVH) in premature infants is linked to several risk factors. Lower gestational age, birth weight, mechanical ventilation, and hyaline membrane disease increase IVH risk.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Clinical Research
Background:
- Intraventricular hemorrhage (IVH) is a significant cause of mortality and morbidity in very low birth weight (VLBW) infants.
- The majority of IVH cases occur within the first three days of life.
Purpose of the Study:
- To identify risk factors associated with high-grade IVH (grades 3 and 4) in VLBW infants.
- To analyze associations between prenatal, delivery, and neonatal factors and severe IVH outcomes.
Main Methods:
- Retrospective case-control study of VLBW infants (<1500g) admitted to Akbar Abadi Hospital.
- Data collected included prenatal, delivery, neonatal course, and cranial ultrasonography reports.
- Multivariate logistic regression analysis was used to determine significant risk factors (p<0.05).
Main Results:
- Lower gestational age, lower birth weight, and mechanical ventilation were strongly associated with high-grade IVH.
- Hyaline membrane disease (HMD), symptomatic hypotension, hypercapnia, and low Apgar scores at 5 minutes also increased IVH risk.
- Tocolytic therapy with magnesium sulfate was identified as a significant risk factor.
Conclusions:
- Several factors, including prematurity, respiratory distress, and hemodynamic instability, contribute to high-grade IVH in VLBW infants.
- Early identification and management of these risk factors are crucial for improving outcomes in VLBW neonates.
- Further research into preventative strategies for IVH in this vulnerable population is warranted.
Abstract:
Intraventricular hemorrhage (IVH) is an important cause of morbidity and mortality in very low birth weight (VLBW) infants; 80-90% of cases occur between birth and the third day of life. In a retrospective case control clinical study, files of all premature infants with birth weights <1500 grams admitted between April 2004 and October 2005 to the Neonatal Intensive Care Unit (NICU) of Akbar Abadi Hospital were reviewed. We determined risk factors that predispose to the development of high-grade IVH (grades 3 and 4) in VLBW infants. Thirty-nine infants with IVH grade 3 and 4 were identified. A control group of 82 VLBW infants were also selected. Prenatal data, delivery characteristics, neonatal course data and reports of cranial ultrasonography were carefully collected for both groups. Those variables that achieved significance (p<0.05) in univariate analysis were entered into multivariate logistic regression analysis. A total of 325 VLBW infants were evaluated. Mortality rate was 21.5%. Multivariate logistic analysis showed that the following factors are associated with greater risk of high-grade IVH occurrence: lower gestational age (OR: 3.72; 95% CI: 1.65-8.38), birth weight (OR: 3.42; 95% CI: 1.65-8.38), mechanical ventilation (OR: 4.14; 95% CI: 1.35-12.2), tocolytic therapy with magnesium sulfate (OR: 4.40; 95% CI: 1.10-24.5), hyaline membrane disease (HMD, OR: 3.16; 95% CI: 1.42-7.45), symptomatic hypotension (OR: 2.32; 95% CI: 1.06-5.42), hypercapnia (OR: 1.9; 95% CI: 1.1-3.4) and Apgar score at 5 minutes (OR: 1.58; 95% CI: 1.59-6.32).
