Periventricular hemorrhage in a developing world. Is drug intervention appropriate?

This study examined the factors associated with the development of periventricular hemorrhage (PVH) in black low-birth weight infants from a disadvantaged community. In addition, the use of drugs as a preventive strategy for the development of PVH was addressed. A total of 177 babies weighing less than 1.5 kg were studied. Eighty (45.2%) were found to have PVH. Grade I PVH was diagnosed in 33 (41.3%), grade II in 37 (46.3%) and grade III in 10 (12.4%) of the babies studied. The overall mortality was 32% (57/177). Mortality of babies with grade I was 33% (11/33), grade II 63% (22/35) and 70% (7/10) for grade III. In those with normal scans the mortality was 18% (17/96). Babies with a lower weight had the severer grade of PVH (P < 0.05). Univariate analyses suggested that lower weight and gestational age, mode of delivery, asphyxia, RDS, shock, hypothermia and the need to administer plasma were the risk factors for both mortality and PVH. However, multiple logistic regression analysis revealed that lower weight (P < 0.001, RR 6.135), asphyxia (P < 0.0004, RR 6.849) and the administration of plasma (P < 0.0026, RR 6.024) were the major factors contributing to death. For the development of PVH weight (P < 0.0001, RR3.719) and the need for plasma (P < 0.03,RR2.079) were crucial. Obstetric complications, place of delivery and booking status did not play a significant role in PVH. The findings in this study suggest that drug intervention in the future may not be appropriate and should be considered when care of the small baby has improved.