Predicting severe intraventricular hemorrhage in very preterm and/or very low birth weight infants: a nomogram...

Severe intraventricular hemorrhage (IVH) is a major brain injury in very preterm and/or very low birth weight infants. We developed a simple model to distinguish severe IVH from mild IVH among very preterm and/or very low birth weight infants with IVH using routinely available perinatal factors.

This retrospective multicenter study included infants born at <32 weeks' gestation and/or with birth weight < 1,500 g admitted to three tertiary neonatal intensive care units (NICUs) in northern China (January 2023-December 2024). IVH was assessed by cranial ultrasonography and graded by the modified Papile system; grades III-IV were defined as severe. Least absolute shrinkage and selection operator (LASSO) and multivariable logistic regression were used to build a nomogram. Discrimination and calibration were evaluated, internal validation was performed using bootstrap resampling, and decision curve analysis was used as an exploratory assessment of clinical utility.

Among 161 infants with IVH, gestational age, base excess (BE), and meningitis-consistent cerebrospinal fluid (CSF) abnormalities were retained as predictors. The apparent C-index/AUC was 0.744 (95% CI: 0.653-0.834), and the optimism-corrected C-index/AUC after bootstrap internal validation was 0.727 (95% CI: 0.646-0.826). The Brier score was 0.171, and the optimism-corrected calibration slope was 0.934.

Among very preterm and/or very low birth weight infants with IVH, a nomogram based on gestational age, BE, and meningitis-consistent CSF abnormalities may help preliminary risk stratification and identify infants who may warrant closer cranial ultrasound surveillance and monitoring. External validation is required before broader clinical implementation.