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Updated: Sep 6, 2025
Modeling Neonatal Intraventricular Hemorrhage Through Intraventricular Injection of Hemoglobin
Published on: August 25, 2022
A predictive clinical model for moderate to severe intraventricular hemorrhage in very low birth weight infants
Rachel M Weinstein1,2, Charlamaine Parkinson3, Allen D Everett4
1Division of Neonatal-Perinatal Medicine, Northwestern University, Chicago, IL, USA.
Insights
A predictive model for intraventricular hemorrhage (IVH) in preterm infants was developed. This tool aids in early risk assessment for better perinatal counseling and targeted therapies.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Medical Informatics
Background:
- Intraventricular hemorrhage (IVH) affects 15-45% of very low birth weight (VLBW) preterm infants.
- Despite advancements in perinatal care, IVH incidence remains high, leading to significant neurodevelopmental abnormalities.
- Early identification of IVH risk is crucial for timely interventions.
Purpose of the Study:
- To develop a predictive clinical model for IVH risk in VLBW infants within hours of birth.
- To enhance perinatal counseling and guide the timing of targeted therapies for IVH prevention or management.
Main Methods:
- Prospective observational cohort study of VLBW infants (2011-2019) at Johns Hopkins Children's Center.
- IVH presence and severity assessed via head ultrasound using the modified Papile classification.
- Absolute risk regression identified significant clinical predictors for the predictive model.
Main Results:
- The study included 798 VLBW infants; 14.4% experienced moderate to severe IVH (grades II-IV).
- Higher gestational age, 5-minute Apgar score, hematocrit, and platelet count were associated with decreased IVH incidence.
- The predictive model demonstrated strong performance (ROC 0.826).
Conclusions:
- The developed predictive model can aid in early IVH risk assessment for VLBW infants.
- This tool supports improved perinatal counseling and informs targeted therapeutic strategies.
- Early prediction is vital for preventing long-term neurodevelopmental sequelae in preterm infants.
Importance:
Intraventricular hemorrhage (IVH) occurs in 15-45% of all very low birth weight (VLBW) preterm infants. Despite improvements in the perinatal care, the incidence of IVH remains high. As more preterm infants survive, there will be a larger burden of neurodevelopmental abnormalities borne by former preterm infants.
Objective:
The objective of this study was to develop a predictive clinical model of IVH risk within the first few hours of life in an effort to augment perinatal counseling and guide the timing of future targeted therapies aimed at preventing or slowing the progression of disease.
Design:
This is a prospective observational cohort study of VLBW infants born in the NICU at John's Hopkins Children's Center from 2011 to 2019. The presence and severity of IVH was defined on standard head ultrasound screening (HUS) using the modified Papile classification. Clinical variables were identified as significant using absolute risk regression from a general linear model. The model predictors included clinically meaningful variables that were not collinear.
Setting:
This study took place at the Johns Hopkins Children's Center Level IV NICU.
Participants:
The study sample included VLBW infants treated in the neonatal intensive care unit (NICU) at John's Hopkins Children's Center from 2011 to 2019. A total of 683 infants included in the study had no or grade I IVH, and 115 infants had grades II through IV IVH. Exclusion criteria included admission to the JHH NICU after 24 h of age, BW > 1500 g, and failure to consent.
Main Outcome:
The main outcome of this study was the presence of grades II-IV IVH on standard head ultrasound screening using the modified Papile classification [1].
Results:
A total of 798 VLBW infants were studied in this cohort and 14.4% had moderate to severe IVH. Fifty four percent of the cohort was black, 33% white, and half of the cohort was male. A higher gestational age, 5-min Apgar score, hematocrit, and platelet count were significantly associated with decreased incidence of IVH in a multi-predictor model (ROC 0.826).
Conclusion And Relevance:
In the face of continued lack of treatments for IVH, prevention is still a primary goal to avoid long-term developmental sequela. This model can be used for perinatal counseling and may provide important information during the narrow therapeutic window for targeted prevention therapies.
