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A Systematic Review and Meta-analysis of the Timing of Early Intraventricular Hemorrhage in Preterm Neonates:
Sameer Yaseen Al-Abdi1, Maryam Ali Al-Aamri2
1Department of Pediatrics, King Abdulaziz National Guard Hospital, Al-Ahsa, Saudi Arabia.
Insights
Intraventricular hemorrhage (IVH) in preterm infants most often occurs in the first 6 hours of life (HOL). This early IVH has significant implications, suggesting screening ultrasounds around 6 HOL for at-risk neonates.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Medical Research Methodology
Background:
- Intraventricular hemorrhage (IVH) is a common complication in preterm neonates.
- A clear definition and understanding of the timing of early IVH are lacking in current literature.
- The temporal relationship between IVH and its potential causes needs further investigation.
Purpose of the Study:
- To systematically review and define "early IVH" based on its occurrence within the first hours of life (HOL).
- To analyze the timing of IVH onset in preterm neonates using a meta-analysis.
- To establish the implications of early IVH and recommend screening protocols.
Main Methods:
- Systematic review of prospective studies on IVH onset in preterm neonates.
- Literature search across three databases up to March 2013.
- Meta-analysis of pooled IVH proportions from studies conducted post-antenatal steroid and surfactant use.
Main Results:
- 16 studies were identified, comparing four IVH timing periods: 0-6, 7-12, 13-24, and after 24 HOL.
- The 0-6 HOL period (48%) and after 24 HOL (38%) were the most frequent times for IVH in neonates ≤1500g.
- The first 6 HOL represent the most vulnerable period for IVH.
Conclusions:
- "Early IVH" is defined as occurring within the first 6 HOL due to its high incidence and vulnerability.
- Early IVH has significant prognostic, etiological, preventive, and medicolegal implications.
- Routine head ultrasounds around 6 HOL are recommended for preterm neonates at risk; further research on long-term outcomes is needed.
Abstract:
A considerable number of intraventricular hemorrhages (IVH) occur within the first hours of life (HOL). Temporality between IVH and its antecedents as well as a consistent definition of "early IVH" is lacking in a large and growing body of literature. We performed a systematic review of prospective studies that reported onset of IVH in preterm neonates within the first HOL and afterwards. The English literature was searched using three databases up to March 2013. Four timing periods of IVH can be compared in 16 identified studies: 0-6; 7-12; 13-24; after 24 HOL. The 0-6 and after 24 HOL were the major modes of IVH timing. Pooled IVH proportions were estimated through a meta-analysis of studies that were conducted after antenatal steroid and surfactant era. In neonates weighing ≤1500 g at birth: 48% of IVH (95% CI: 42-58%, 5 studies, 279 IVH cases) occurred during 0-6 HOL and 38% (95% CI: 19-57%, 4 studies, 241 IVH cases) after 24 HOL. The 0-6 HOL is the shortest, most vulnerable period for IVH, thus, an early IVH is an IVH occurs in it. Such early IVH had prognostic, etiological/preventive and medicolegal implications. Accordingly, preterm neonates at risk of IVH should have their first routine screening head ultrasound at about 6 HOL. Future research exploring the antecedents of IVH should guaranty the temporality between these antecedents and IVH. Additional research will be required to determine whether the long term neurological outcomes of early and late IVH are the same.
