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Risk factors for periventricular-intraventricular haemorrhage severity in preterm infants: a propensity score-matched
Jinglan Huang1,2, Yan Wang1,2,3, Tian Tian4
1Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.
Insights
Electrolyte imbalances, sepsis, low platelets, and mechanical ventilation increase the risk of brain bleeds (PV-IVH) in preterm infants. These factors also worsen the severity of PV-IVH, independent of gestational age.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Critical Care Medicine
Background:
- Periventricular-intraventricular haemorrhage (PV-IVH) is a significant concern in preterm infants.
- While younger gestational age (GA) is a known risk factor, other contributing factors to PV-IVH severity require further investigation.
Purpose of the Study:
- To identify risk factors for the development and severity of PV-IVH in preterm infants (less than 28 weeks GA) independent of gestational age.
- To analyze the association of specific clinical conditions with PV-IVH incidence and severity.
Main Methods:
- Retrospective case-control study of preterm infants (2009-2020) with PV-IVH diagnosed via cranial ultrasound.
- Propensity score matching was used to control for gestational age when comparing groups (no PV-IVH vs. PV-IVH; mild PV-IVH vs. severe PV-IVH).
- Multivariate logistic regression identified independent risk factors.
Main Results:
- The incidence of PV-IVH was 55.6%, with mild and severe cases at 28.7% and 26.9% respectively.
- Independent risk factors for PV-IVH included electrolyte disorder, early-onset sepsis, thrombocytopenia, invasive mechanical ventilation, and male sex.
- Electrolyte disorder, thrombocytopenia, and invasive mechanical ventilation were independently associated with severe PV-IVH.
Conclusions:
- Electrolyte disorder, early-onset sepsis, thrombocytopenia, invasive mechanical ventilation, and male sex are significant risk factors for PV-IVH in preterm infants, irrespective of gestational age.
- These factors also contribute to the severity of PV-IVH.
- Identifying and managing these risk factors may help predict and potentially prevent PV-IVH and its severe forms in vulnerable preterm infants.
Background:
Most previous studies comparing etiological studies in infants with and without periventricular-intraventricular haemorrhage (PV-IVH) concluded that younger gestational age (GA) was associated with a higher prevalence rate of PV-IVH. However, only a few studies have examined the risk factors associated with the severity of PV-IVH after removing the influence of GA. Therefore, we investigated the risk factors apart from GA for PV-IVH severity in preterm infants less than 28 weeks.
Methods:
This was a retrospective case-control study of preterm infants born in West China Second Hospital with PV-IVH between 2009 and 2020. PV-IVH was defined using cranial ultrasound screening. Preterm infants were divided into no PV-IVH and PV-IVH groups, and preterm infants with PV-IVH were divided into mild and severe PV-IVH groups. Groups were matched in a 1:1 ratio using propensity score calculated from GA. Variables were collected from infant-mother pairs. A stepwise forward multivariate logistic regression model was adopted to select factors that affected PV-IVH in preterm infants.
Results:
A total of 429 preterm infants were included. The total incidence of PV-IVH in preterm infants was 55.6%, and the incidence of mild and severe PV-IVH was 28.7% and 26.9%, respectively. We matched 162 infants with no PV-IVH with 162 infants with PV-IVH. The results suggested that electrolyte disorder (OR 2.79, 95% CI: 1.34-5.77), early-onset sepsis (OR 1.76, 95% CI: 1.01-3.08), thrombocytopenia (OR 2.87, 95% CI: 1.10-7.48), invasive mechanical ventilation (OR 4.21, 95% CI: 1.86-9.55), and male sex (OR 2.16, 95% CI: 1.29-3.60) were independently associated with PV-IVH. Then, we matched 87 infants with mild PV-IVH with 87 infants with severe PV-IVH. The results suggested that electrolyte disorder (OR 2.88, 95% CI: 1.29-6.45), thrombocytopenia (OR 5.73, 95% CI: 1.91-17.14), and invasive mechanical ventilation (OR 10.54, 95% CI: 1.16-95.85) were independently associated with severity of PV-IVH.
Conclusions:
Regardless of GA, electrolyte disorder, early-onset sepsis, thrombocytopenia, invasive mechanical ventilation, and male sex contributed to PV-IVH in preterm infants, and electrolyte disorder, thrombocytopenia, and invasive mechanical ventilation contributed to severe PV-IVH. These risk factors may combine to predict the incidence of PV-IVH in preterm infants.
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