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Ante-, peri- and postnatal factors associated with intraventricular hemorrhage in very premature infants
Martin Poryo1, Judith Caroline Boeckh2, Ludwig Gortner3
1Department of Pediatric Cardiology, Saarland University Medical Center, Homburg/Saar, Germany.
Insights
Intraventricular hemorrhage (IVH) in preterm infants is linked to immaturity and critical clinical events. Identifying these factors is crucial for reducing IVH incidence in premature babies.
Area of Science:
- Neonatalogy
- Perinatology
- Pediatric Neurology
Background:
- Intraventricular hemorrhage (IVH) is a severe complication in preterm infants, linked to neurological issues and mortality.
- Despite improved neonatal care, IVH affects 15-25% of very and extremely premature infants.
- Gestational age and birth weight are known risk factors, but other associated factors require further investigation.
Purpose of the Study:
- To conduct an updated, multicenter analysis identifying ante-, peri-, and postnatal factors associated with IVH in very premature infants.
- To analyze factors beyond gestational age and birth weight that contribute to IVH occurrence.
- To provide insights for targeted interventions to reduce IVH rates.
Main Methods:
- Retrospective analysis of a prospectively conducted multicenter cohort study (1998-2012).
- Inclusion of 765 infants with gestational age < 32 weeks from 5 level 3 perinatal centers.
- Univariate and multivariate logistic regression analyses of collected ante-, peri-, and neonatal data.
Main Results:
- Multivariate analysis identified higher gestational age, antenatal steroid treatment, and C-section without contractions as protective against IVH.
- Respiratory distress syndrome (RDS), pneumothorax, and catecholamine use were associated with increased IVH risk.
- Excluding gestational age/birth weight, early onset sepsis and patent ductus arteriosus were linked to higher IVH rates.
Conclusions:
- IVH in very premature infants is significantly associated with factors related to immaturity and critical postnatal clinical courses.
- The findings highlight the importance of collaboration between obstetricians and neonatologists.
- Close monitoring and management of identified risk factors are essential for reducing IVH incidence.
Background:
Intraventricular hemorrhage (IVH) is one of the most serious complications in preterm infants and is associated with neurological sequelae and mortality. Over the past few decades, the rate of IVH has decreased due to improved neonatal intensive care. However, up to 15-25% of very and extremely premature infants (<32 and <28weeks of pregnancy (WOP) respectively) still suffer from IVH.
Study Purpose:
The aim of this study was to perform an updated, multicenter analysis to identify ante-, peri, and postnatal factors other than gestational age/birth weight associated with IVH of any grade in a large cohort of very and extremely premature infants.
Methods:
We performed a retrospective analysis in a prospectively conducted multicenter cohort study between 01/01/1998-31/12/2012 at 5 level 3 perinatal centers. All relevant ante-, peri- and neonatal data were collected and univariate as well as multivariate logistic regression analysis was performed.
Results:
765 inborn infants with a gestational age<32 WOP were enrolled into this study (369 (48.2%) female; 396 (51.8%) male). Birth weight ranged from 315g to 2200g (mean 1149.7g, SD 371.9g); 279 (36.5%) were born ≤27+6 WOP and 486 (63.5%)≥28+0 WOP. IVH was seen in 177 (23.1%) patients. Multivariate analysis revealed that in addition to higher gestational age (OR 0.7, CI [0.6-0.8]), antenatal steroid treatment (OR 0.3, CI [0.2-0.6]) and caesarian section without uterine contraction (OR 0.6, CI [0.4-0.9]) were associated with a lower rate of IVH while RDS (OR 5.6, CI [1.3-24.2]), pneumothorax (OR 2.8, CI [1.4-5.5]) and use of catecholamines (OR 2.7, CI [1.7-4.5]) were associated with an increased risk of IVH. After exclusion of gestational age and birth weight from multivariate analysis, early onset sepsis (OR 1.6, CI [1.01-2.7]) and patent ductus arteriosus (OR 1.9, CI [1.1-3.1]) were associated with a higher rate of IVH. In addition, univariate analysis revealed that Apgar scores at 5min (p<0.001), BDP/ROP/NEC (p<0.001), mechanical ventilation (p<0.001) and inhalative nitric oxide (p<0.001) were significantly associated with IVH.
Conclusions:
Our comprehensive analysis demonstrated that the occurrence of IVH in very premature infants is significantly associated with ante-, peri- and postnatal factors being either related to the degree of immaturity or indicating a critical clinical course after birth. The analysis reiterates the necessity for a very close cooperation between obstetricians and neonatologists to reduce the incidence of IVH in this susceptible cohort.
