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Improving incidence trends of severe intraventricular haemorrhages in preterm infants <32 weeks gestation: a cohort
Kee Thai Yeo1,2, Reji Thomas1,3, Sharon Sw Chow4,5
1Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia.
Insights
Severe intraventricular haemorrhage (IVH) rates decreased in preterm infants (<32 weeks gestation) over 18 years. This reduction in severe IVH coincided with fewer risk factors and improved survival for these vulnerable infants.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Public Health
Background:
- Severe intraventricular haemorrhage (IVH) is a significant complication in extremely preterm infants.
- Understanding trends and risk factors for IVH is crucial for improving neonatal outcomes.
Purpose of the Study:
- To investigate the temporal trends of severe IVH in infants born before 32 weeks gestation.
- To identify risk factors associated with the development of severe IVH in this population.
Main Methods:
- A population-based cohort study was conducted using data from the Australian and New Zealand Neonatal Network (ANZNN).
- Infants born <32 weeks gestation between 1995 and 2012 were analyzed across three 6-year epochs.
- Incidence of IVH and severe IVH was compared between epochs, with adjusted analyses for risk factors.
Main Results:
- Over 60,000 infants were included; survival to discharge increased from 89% to 93%.
- The incidence of severe IVH decreased significantly from 4.0% to 2.8% across epochs (p<0.001).
- Key risk factors for severe IVH included lack of antenatal steroids, male sex, low Apgar score, intubation at birth, extreme prematurity, outborn status, and vaginal delivery.
Conclusions:
- The incidence of severe IVH has declined in extremely preterm infants over an 18-year period.
- This decrease is associated with improved survival rates and a reduction in identified risk factors.
- Continued focus on antenatal care and management of perinatal factors is essential for further reducing severe IVH.
Objective:
To describe the trend and risk factors for severe intraventricular haemorrhage (IVH) among infants <32 weeks gestation.
Design:
Population-based cohort study.
Setting:
Australia and New Zealand.
Patients:
All preterm infants <32 weeks gestation in the Australian and New Zealand Neonatal Network (ANZNN) from 1995 to 2012.
Interventions:
Comparison of IVH incidence between 6-year epochs.
Main Outcome Measures:
Overall IVH and severe IVH incidence.
Results:
A total of 60 068 infants were included, and overall survival to discharge increased from 89% to 93% over the three epochs. As the percentage of infants with IVH decreased from 23.6% to 21.3% and 21.4% (p<0.001) from epoch 1 to 3, respectively, fewer survivors had severe IVH (4.0%, 3.3% and 2.8%, respectively, p<0.001). Over time, there were fewer antenatal complications, higher antenatal steroid usage and more caesarean-section births. Fewer infants were intubated at birth, had low 5 min Apgar score, had sepsis or pneumothorax needing drainage. Adjusted for perinatal confounders, there was significant reduction in odds of severe IVH from epoch 1 to 3 (adjusted OR (AOR) 0.8, 95% CI 0.7 to 0.9). Factors associated with development of severe IVH include no antenatal steroids (AOR 1.7, 95% CI 1.5 to 1.9), male (AOR 1.3, 95% CI 1.2 to 1.4), 5 min Apgar score <7 (AOR 2.0, 95% CI 1.9 to 2.2), intubated at birth (AOR 2.0, 95% CI 1.8 to 2.2), extremely low gestational age (AOR 4.0, 95% CI 3.7 to 4.4), outborn (AOR 1.6, 95% CI 1.5 to 1.8) and vaginal delivery (AOR 1.4, 95% CI 1.3 to 1.6).
Conclusions:
Along with increased survival among infants born <32 weeks gestation, the incidence of severe IVH has decreased over the 18 years, especially in the most recent period. This coincided with reduction in rates of risk factors for severe IVH development.
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