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Published on: August 25, 2022
Effects of intubation and hypoxemia on intraventricular hemorrhage in preterm infants during the first week: An
Yu-Ting Chen1, Hsiang-Ping Wu2, Hsiang-Yun Lan1
1School of Nursing, National Defense Medical Center, No. 161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City, 114201 Taiwan, ROC.
Insights
Intubation within three days of birth is a key factor for intraventricular hemorrhage (IVH) in preterm infants. Hypoxemia and ventilation duration also increase IVH risk, highlighting the need for careful neonatal intensive care unit (NICU) management.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Critical Care
Background:
- Preterm infants face risks of neurodevelopmental disabilities, particularly from intraventricular hemorrhage (IVH).
- Limited research exists on the impact of oxygen saturation (SpO2) fluctuations and intubation on IVH development in this vulnerable population.
Purpose of the Study:
- To investigate the influence of intubation and varying hypoxemia thresholds on the incidence of IVH in preterm infants.
- To assess these risks within the first week of neonatal intensive care unit (NICU) admission.
Main Methods:
- A prospective observational cohort study included preterm infants (<37 weeks gestational age) from two Level III NICUs.
- Continuous SpO2 monitoring via electrocardiography and IVH assessment via cranial ultrasonography were employed.
- Generalized estimating equations analyzed the association between intubation, hypoxemia rates (<80%, <85%, <90%), and IVH risk.
Main Results:
- Intubation within 3 days, mechanical ventilation duration, oxygen use, hypoxemia rates, and maternal magnesium sulfate use were linked to IVH.
- Multivariate analysis confirmed intubation as a significant factor associated with IVH across all hypoxemia thresholds (p=0.004).
Conclusions:
- While hypoxemia, ventilation, and magnesium sulfate use correlate with IVH, intubation emerges as the primary risk factor.
- Early intubation in preterm infants (<3 days) significantly increases the likelihood of developing intraventricular hemorrhage.
Background:
Preterm infants with intraventricular hemorrhage (IVH) are at a risk of developing neurodevelopmental disabilities. Few studies have examined the effects of oxygen saturation (SpO2) changes and intubation procedures on the risk of IVH.
Objectives:
We examined the effects of intubation and the rates of three thresholds of hypoxemia on the occurrence of IVH in preterm infants during their first week in the neonatal intensive care unit (NICU).
Methods:
In this prospective observational cohort study, preterm infants with a gestational age (GA) of <37 weeks were included from two Level III NICUs in Taiwan. Continuous electrocardiography was used to monitor SpO2 changes, and cranial ultrasonography was used to monitor IVH. Thresholds of hypoxemia (SpO2 levels of <80 %, <85 %, and <90 %) were screened by digitally sampling data at 10-s intervals. Generalized estimating equations were used with logistic regression to analyze the effects of intubation and the rates of the three thresholds of hypoxemia on the risk of IVH during the first week after birth.
Results:
In all preterm infants (N = 73), the mean GA was 31.55 weeks, and the mean birth weight was 1508.86 g. Intubation within 3 days of birth, duration of mechanical ventilation and oxygen use, hypoxemia rate, and maternal use of magnesium sulfate before and during delivery were significantly associated with IVH. A multivariate analysis revealed that intubation was a key factor associated with the occurrence of IVH across different thresholds of hypoxemia (p = 0.004).
Conclusions:
Although the rate of hypoxemia, duration of mechanical ventilation and oxygen use, and maternal use of magnesium sulfate were significantly associated with IVH, intubation within 3 days of birth was the key factor responsible for increased IVH risk.
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