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Published on: January 12, 2018
Risk factors for intraventricular hemorrhage in very low birth weight infants: a systematic review and meta-analysis
1The Second Affiliated Hospital of Wenzhou Medical University, Zhejiang, China.
Insights
Intraventricular Hemorrhage (IVH) is a serious complication in Very Low Birth Weight (VLBW) infants. This meta-analysis identified hypotension, PDA, and sepsis as key risk factors, while antenatal corticosteroids showed protective effects.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Clinical Epidemiology
Background:
- Intraventricular Hemorrhage (IVH) is a significant complication in Very Low Birth Weight (VLBW) infants, often leading to long-term neurodevelopmental issues.
- Previous research on IVH risk factors in VLBW infants has yielded inconsistent results.
- A systematic evaluation and meta-analysis were needed to clarify these risk factors.
Purpose of the Study:
- To systematically evaluate and meta-analyze existing evidence to identify major risk factors for Intraventricular Hemorrhage (IVH) in Very Low Birth Weight (VLBW) infants.
- To provide a comprehensive overview of factors associated with IVH development in this vulnerable population.
- To inform potential early intervention strategies by clarifying etiological factors.
Main Methods:
- A systematic literature search was conducted across PubMed, Web of Science, Embase, and Cochrane Library.
- Observational studies (case-control and cohort) published up to January 2025 were included.
- Meta-analysis was performed using Stata 15.0 to calculate pooled odds ratios (OR) and 95% confidence intervals (CI) for identified risk factors.
Main Results:
- The meta-analysis included 21 studies with 13,800 VLBW infants.
- Identified risk factors for IVH included hypotension (OR=3.64), patent ductus arteriosus (PDA) (OR=1.86), vaginal delivery (OR=2.10), neonatal thrombocytopenia (OR=2.43), pulmonary hemorrhage (OR=2.45), mechanical ventilation (OR=2.09), and sepsis (OR=2.28).
- Antenatal corticosteroids were found to be a protective factor against IVH (OR=0.68).
Conclusions:
- Hypotension, PDA, vaginal delivery, neonatal thrombocytopenia, pulmonary hemorrhage, mechanical ventilation, and sepsis are significant risk factors for IVH in VLBW infants.
- Antenatal corticosteroid use demonstrates a protective effect against IVH in VLBW infants.
- Integrating clinical and preclinical findings is crucial for a deeper understanding of IVH pathogenesis and for developing effective early interventions.
Background:
Intraventricular Hemorrhage (IVH) is one of the common and serious complications of Very Low Birth Weight Infant (VLBW) that may lead to long-term neurodevelopmental deficits. Although several studies have been conducted to explore its risk factors, the results have been inconsistent. The aim of this study was to identify the major risk factors for intraventricular Hemorrhage in VLBW by systematic evaluation and Meta-analysis of the available evidence.
Methods:
PubMed, Web of Science, Embase, Cochrane Library were systematically searched, and observational studies (case-control and cohort studies) were included from the time of library construction to 20 January 2025, and the literature that met the criteria were screened and relevant data were extracted. Meta-analysis was performed using Stata 15.0 software to assess the combined odds ratio (OR) and 95% confidence interval (CI) for each risk factor.
Results:
A total of 21 studies included 6 case-control studies, 15 cohort studies, involving a total of 13,800 patients, The results of the meta-analysis showed that hypotension [OR = 3.64, 95%CI (1.87, 7.08)], patent ductus arteriosus (PDA) [OR = 1.86, 95%CI (1.46, 2.36)], vaginal delivery [OR = .10, 95%CI (1.61, 2.72)], neonatal thrombocytopenia[OR = 2.43, 95%CI (1.79, 3.30)], pulmonary hemorrhage [OR = 2.45, 95%CI (1.43, 4.20)], mechanical [OR = 2.09, 95%CI (1.40, 3.10)], sepsis[OR = 2.28, 95%CI (1.77, 2.95)] were a risk factor for the development of IVH in VLBW. While antenatal corticosteroids [OR = 0.68, 95%CI (0.55, 0.84)] was a protective factor for the development of IVH in VLBW.
Conclusion:
This study indicates that hypotension, patent ductus arteriosus (PDA), antenatal corticosteroid use, vaginal delivery, neonatal thrombocytopenia, pulmonary hemorrhage, mechanical ventilation, and sepsis constitute the primary risk factors for IVH in VLBW infants. Although these factors exhibit strong clinical associations, current understanding of IVH pathogenesis remains largely dependent on preclinical studies. Integrating clinical and preclinical evidence facilitates a more comprehensive understanding of IVH etiology and informs early intervention strategies.
Systematic Review Registration:
identifier CRD42025633474.
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