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Published on: August 25, 2022
Temporal trends in intraventricular hemorrhage in preterm infants: A Brazilian multicenter cohort
Luís Eduardo de Figueiredo Vinagre1, Jamil Pedro de Siqueira Caldas2, Sergio Tadeu Martins Marba2
1Womens' Hospital, State University of Campinas, Unicamp 101, Alexander Fleming St, Barao Geraldo, Campinas, Sao Paulo, Brazil 13083-881.
Insights
Intraventricular hemorrhage (IVH) incidence is high in Brazilian preterm infants, showing an increasing trend over time. Severe IVH rates are also a significant concern, demanding further attention and research.
Area of Science:
- Neonatal Research
- Pediatric Neurology
- Public Health
Background:
- Intraventricular hemorrhage (IVH) poses a significant threat to preterm infants.
- Data on IVH incidence in Brazil has been lacking.
- Understanding national trends is crucial for targeted interventions.
Purpose of the Study:
- To determine the incidence and temporal trends of IVH in very low birth weight (VLBW) preterm infants.
- To analyze IVH rates across 18 centers in the Brazilian Network on Neonatal Research.
- To identify variations in IVH incidence and severity among participating centers.
Main Methods:
- A prospective, multicenter cohort study was conducted.
- Inclusion criteria: inborn VLBW preterm infants (23 0/7–33 6/7 weeks' gestation) from 2013–2018.
- Statistical models adjusted for perinatal and neonatal variables to compare center-specific rates.
Main Results:
- A total of 6,420 infants were included; 30.4% experienced IVH.
- A significant increasing trend in overall IVH incidence was observed over time (p=0.003).
- Severe IVH (grades III-IV) occurred in 32.2% of affected infants with stable incidence; significant inter-center variations in IVH rates persisted after adjustments.
Conclusions:
- The incidence of IVH in this Brazilian cohort is high, with a concerning upward trend.
- Severe IVH rates are also a significant concern.
- Substantial variations in IVH incidence exist among Brazilian neonatal centers.
Background:
Intraventricular hemorrhage (IVH) is a serious problem in preterm infants. Brazilian national data are unknown.
Objective:
To evaluate the incidence and temporal trend of IVH in very low birth weight (VLBW) preterm infants of 18 centers of the Brazilian Network on Neonatal Research.
Study Design:
National prospective multicenter cohort study including inborn VLBW preterm infants aged 230/7- 336/7 weeks' gestation, admitted between 2013 and 2018. The center with the mean incidence rate was used as reference. We applied two adjustments models using perinatal variables, and perinatal + neonatal diseases.
Results:
Of 6,420 infants, 1951/30.4% (range 27.1-33.8%) had IVH and the disease showed a significant trend towards an overall increase in incidence over time (p = 0.003), especially in three centers. Severe IVH (grade III or IV) occurred in 32.2% (range 29.2-34.5%) of those affected by IVH, with a stable incidence. After adjustments for perinatal variables, the differences persisted among centers: for global IVH, 7 centers had significantly lower rates (OR ranging from 0.31 to 0.62), and 2 presented rates higher than the reference center (OR ranging from 2.00 to 12.46) for severe HIV. Considering perinatal and neonatal variables, 6 centers had significantly lower rates (OR ranging from 0.36 to 0.60) for global IVH than the reference center and 3 had statistically higher rates (OR 1.72, 1.86 and 11.78) for severe forms.
Conclusion:
The incidence rate of IVH in this Brazilian cohort was high and it revealed an increasing trend towards over time. The severe IVH rate was also worrisome.
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