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International Variation and Trends of Intraventricular Hemorrhage in Very Preterm Infants

Georgia Hollens1, Tim Schindler1,2, Malcolm Battin3

  • 1School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia.

Neonatology
|June 1, 2025
PubMed

Insights

International rates of severe intraventricular hemorrhage (IVH) in preterm infants vary significantly. However, these rates and the composite outcome of IVH or death have decreased over time across multiple high-income countries.

Area of Science:

  • Neonatalogy
  • Perinatal Medicine
  • Public Health

Background:

  • Severe intraventricular hemorrhage (IVH) is a significant concern in preterm infants.
  • International variations in IVH rates among extremely preterm infants (<30 weeks' gestational age) are not well understood.

Purpose of the Study:

  • To investigate international variations in gestational age (GA)-specific severe intraventricular hemorrhage (IVH) rates.
  • To analyze trends in IVH and composite outcomes over time across neonatal networks in high-income countries.

Main Methods:

  • Retrospective cohort study analyzing data from 165,329 infants across 11 high-income country neonatal networks.
  • Examined rates of grade 3/4 IVH and a composite outcome (grade 3/4 IVH or death) in specific GA groups (22-29 weeks).
  • Assessed risk-adjusted trends across three epochs: 2007-11, 2012-15, and 2016-19.

Main Results:

  • Significant international variation in grade 3/4 IVH rates was observed, with Japan having the lowest (6.4%) and Israel the highest (16.1%).
  • Gestation-specific rates for grade 3/4 IVH ranged from 25.8% (22-23 weeks) to 3.8% (28-29 weeks).
  • Composite outcome rates of grade 3/4 IVH/death also varied significantly by GA and country, decreasing over time, particularly in the 26-27 week GA group.

Conclusions:

  • Rates of severe IVH and composite outcomes in preterm infants differ internationally and have shown a downward trend over time.
  • Identifying factors contributing to these variations can inform practice improvements and enhance care for high-risk neonates.

Keywords:
Intraventricular hemorrhageNeonatal networksVariationsVery preterm infants

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