Obstetric factors and relative risk of neonatal germinal layer/intraventricular hemorrhage

One hundred fifty-five inborn infants with a birth weight less than or equal to 1,500 gm were prospectively evaluated for germinal layer/intraventricular hemorrhage. Maternal characteristics, obstetric factors, and neonatal condition in the immediate newborn period were analyzed as possible risk factors for germinal layer/intraventricular hemorrhage. Early germinal layer/intraventricular hemorrhage or hemorrhages identified during the first 24 hours of life were observed in 85 (55%) of these infants. Another 37 (24%) had germinal layer/intraventricular hemorrhage after 24 hours of age (late germinal layer/intraventricular hemorrhage). None of the maternal and obstetric variables, including labor, mode of delivery, and presentation, appeared to increase the risk of germinal layer/intraventricular hemorrhage. The immediate neonatal condition, birth weight, gestational age, and intrauterine growth, all influenced the occurrence of germinal layer/intraventricular hemorrhage, especially early germinal layer/intraventricular hemorrhage. We suggest that future studies to investigate the role of maternal or obstetric factors in the pathogenesis of germinal layer/intraventricular hemorrhage should discriminate early from late germinal layer/intraventricular hemorrhage. Obstetric factors are more likely to influence the early onset of germinal layer/intraventricular hemorrhage; their effect, if any, becomes less discernible later.