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Neonatal intracranial hemorrhage: I. Changing pattern in inborn low-birth-weight infants
C Strand1, A R Laptook, S Dowling
1Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75235.
Insights
The incidence of periventricular-intraventricular hemorrhage (PVH-IVH) in low-birth-weight infants decreased over three years. This reduction was mainly due to fewer severe PVH-IVH cases, highlighting the need for ongoing monitoring.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Medical Imaging
Background:
- Periventricular-intraventricular hemorrhage (PVH-IVH) is a common complication in premature infants.
- Previous studies on PVH-IVH incidence may be biased by including both inborn and outborn neonates.
- Understanding trends in PVH-IVH is crucial for improving neonatal care.
Purpose of the Study:
- To determine if the incidence of PVH-IVH changed over a 3-year period in a solely inborn population of low-birth-weight infants.
- To identify factors contributing to any observed changes in PVH-IVH rates.
- To assess the significance of late-onset PVH-IVH.
Main Methods:
- A retrospective analysis of 463 inborn infants with birth weight ≤ 1500 g who survived > 8 hours.
- Serial cranial ultrasonography was used to diagnose PVH-IVH.
- Data were collected over a 3-year interval (March 1982 - February 1985).
Main Results:
- The overall incidence of PVH-IVH decreased significantly from 31.5% in year 1 to 23.7% in year 3 (P<0.05).
- The decrease was primarily driven by a reduction in severe PVH-IVH (grades III and IV).
- A notable 21.9% of PVH-IVH cases were diagnosed after 14 days of age, predominantly grade I.
Conclusions:
- A declining trend in PVH-IVH incidence was observed in this inborn low-birth-weight population.
- The reduction in severe hemorrhages suggests potential improvements in care or evolving epidemiology.
- Serial ultrasonography beyond the first week is important for detecting late-onset PVH-IVH.
Abstract:
Many reports of the occurrence of periventricular-intraventricular hemorrhage (PVH-IVH) are biased by the inclusion of both inborn and outborn infants. To obviate this selection bias we examined a large inborn population of low-birth-weight infants to determine if the incidence of PVH-IVH changed over a 3-year interval from March, 1982 through February, 1985. Serial cranial ultrasonography was performed in 463 consecutive infants of birth weight less than or equal to 1500 g who survived for more than 8 h. The incidence of PVH-IVH decreased from 31.5% and 29.3% in years 1 and 2, respectively, to 23.7% in year 3 (P less than 0.05). The latter reflected a fall in the incidence of grades III and IV PVH-IVH, but no change in the incidence of grades I and II. This observation was not attributable to changes in mortality, the distribution of infants by birth weight and estimated gestational age in each year of the study, or infants excluded from the analysis. Contrary to most reports, 21.9% of all PVH-IVH during the 3 years were first diagnosed after 14 days postnatal age and were predominantly grade I. These results document not only a change in the epidemiology of PVH-IVH in an inborn population, but also the importance of serial cranial ultrasonography beyond the first week of life.