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Intraventricular haemorrhage in a Ugandan cohort of low birth weight neonates: the IVHU study
R MacLeod1, J N Paulson2, N Okalany1
1Neonatal Unit, Mbale Regional Referral Hospital, P.O. Box 1966, Mbale, Uganda.
Insights
Intraventricular hemorrhage (IVH) affects over a third of low birth weight neonates in Uganda, primarily within the first week. Vaginal birth, preterm gestation, and resuscitation increase IVH risk, highlighting the need for antenatal steroid research.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Global Health
Background:
- Premature birth globally affects 15 million neonates annually, with over half in low-income countries (LICs).
- Premature and low birth weight neonates face an elevated risk of intraventricular hemorrhage (IVH).
- Limited data exist on IVH prevalence and risk factors in sub-Saharan Africa.
Purpose of the Study:
- To investigate the incidence, severity, and timing of IVH.
- To identify modifiable risk factors for IVH in low birth weight neonates in Uganda.
- To assess 28-day survival rates in relation to IVH.
Main Methods:
- A prospective cohort study involving 120 neonates with birth weights ≤2000g admitted to a neonatal unit in eastern Uganda.
- Cranial ultrasound (cUS) scans were performed on days 0, 3, 7, and 28.
- Maternal data and neonatal risk factors were collected; odds ratios (ORs) and adjusted odds ratios (aORs) were calculated.
Main Results:
- IVH was diagnosed in 34.2% of neonates, with 15% having high-grade IVH (Papile grades 3-4).
- The majority of IVH cases (90.2%) occurred by day 7.
- Vaginal delivery, gestational age <32 weeks, and neonatal resuscitation were associated with increased IVH odds. No IVH was observed in 6 neonates receiving antenatal steroids.
Conclusions:
- Over one-third of neonates weighing ≤2000g in this resource-limited Ugandan setting experienced IVH, predominantly within the first week.
- Risk factors identified include vaginal birth, preterm gestation, and the need for resuscitation.
- Further research into SGA neonates and the role of antenatal steroids in LICs is crucial.
Background:
Globally, 15 million neonates are born prematurely every year, over half in low income countries (LICs). Premature and low birth weight neonates have a higher risk of intraventricular haemorrhage (IVH). There are minimal data regarding IVH in sub-Saharan Africa. This study aimed to examine the incidence, severity and timing of and modifiable risk factors for IVH amongst low-birth-weight neonates in Uganda.
Methods:
This is a prospective cohort study of neonates with birthweights of ≤2000 g admitted to a neonatal unit (NU) in a regional referral hospital in eastern Uganda. Maternal data were collected from interviews and medical records. Neonates had cranial ultrasound (cUS) scans on the day of recruitment and days 3, 7 and 28 after birth. Risk factors were tabulated and are presented alongside odds ratios (ORs) and adjusted odds ratios (aORs) for IVH incidence. Outcomes included incidence, timing and severity of IVH and 28-day survival.
Results:
Overall, 120 neonates were recruited. IVH was reported in 34.2% of neonates; 19.2% had low grade (Papile grades 1-2) and 15% had high grade (Papile grades 3-4). Almost all IVH (90.2%) occurred by day 7, including 88.9% of high grade IVH. Of those with known outcomes, 70.4% (81/115) were alive on day 28 and survival was not associated with IVH. We found that vaginal delivery, gestational age (GA) < 32 weeks and resuscitation in the NU increased the odds of IVH. Of the 6 neonates who received 2 doses of antenatal steroids, none had IVH.
Conclusion:
In this resource limited NU in eastern Uganda, more than a third of neonates born weighing ≤2000 g had an IVH and the majority of these occurred by day 7. We found that vaginal birth, earlier gestation and need for resuscitation after admission to the NU increased the risk of IVH. This study had a high rate of SGA neonates and the risk factors and relationship of these factors with IVH in this setting needs further investigation. The role of antenatal steroids in the prevention of IVH in LICs also needs urgent exploration.
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