Perinatal Neuroprotective Strategies and Intraventricular Hemorrhage in Preterm Infants ≤32 Weeks' Gestational Age: A...

Background Intraventricular hemorrhage (IVH) is a major complication of prematurity and a significant contributor to increased morbidity and mortality. There is no single intervention to eliminate IVH; however, implementing perinatal neuroprotective strategies (NPS) may help minimize adverse outcomes. Indian data on perinatal NPS and their association with IVH remains limited. Purpose The aim of this study was to compare IVH incidence before and after implementation of perinatal NPS (antenatal neuroprotection and postnatal IVH care bundle) in preterm infants ≤32 weeks' gestational age (GA). Secondary objectives were to identify risk factors associated with IVH and to determine the incidence of cystic periventricular leukomalacia (cPVL). Methods Baseline incidence of IVH was reviewed retrospectively from case records of the year 2019 among all preterm infants ≤32 weeks' GA. During the study period (July 2020 to December 2021), preterm infants ≤32 weeks' GA who received NPS during the antenatal (antenatal steroids and magnesium sulfate) and postnatal (IVH care bundle) periods were included. Assessment for IVH and cPVL was performed using neurosonography during the hospital stay and at 38-40 weeks' GA, respectively. Results A total of 421 preterm infants were included. IVH incidence was similar in the 2019 baseline cohort and during July 2020 to December 2021 (71/414 [17.15%] vs 63/421 [14.96%]; OR 1.18, CI 0.81-1.70, p = 0.39). Mean GA and mean birth weight (BW) were 30 week + 1 day (SD ±1.7) and 1,217.19 g (SD ±309.4), respectively. The overall incidence of IVH was 63/421 (14.96%), and the incidence of severe IVH (grade ≥ 3) was 9/421 (2.14%). On logistic regression analysis, GA<28 weeks (adjusted odds ratio [aOR] 2.44), BW < 1,000 g (aOR 3.61), and acidosis (aOR 2.65) were associated with IVH. The incidence of cPVL was 21/348 (6.03%). Conclusion Perinatal NPS did not influence IVH incidence; however, the absence of a concurrent parallel comparison group limits inference. The incidence of severe IVH (grade ≥ 3) remained low. Extreme prematurity, extremely low BW, and metabolic acidosis were key factors associated with IVH.