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Should preterm infants born after 29 weeks' gestation be screened for intraventricular haemorrhage?
D Harding1, C Kuschel, N Evans
1Department of Neonatal Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
Insights
Routine ultrasound screening for intraventricular haemorrhage (IVH) in preterm infants born after 29 weeks gestation is not cost-effective due to low incidence. Clinical concern should guide IVH screening in this population.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Medical Ultrasound
Background:
- Intraventricular haemorrhage (IVH) is a significant concern in preterm infants.
- The cost-effectiveness of routine screening for IVH in specific preterm populations requires evaluation.
Purpose of the Study:
- To assess the incidence of grade 2 or higher IVH in preterm infants born after 29 weeks gestation.
- To determine if routine ultrasound screening is justified by the incidence and cost.
- To identify clinical indicators for IVH risk in more mature preterm infants.
Main Methods:
- A cohort study of 800 preterm infants (436 born after 29 weeks gestation) between 1992 and 1996.
- Collection of demographic and clinical data from a prospectively maintained database.
- Calculation of screening costs using the Medicare schedule charge rate for cerebral ultrasound.
Main Results:
- The incidence of grade 2 or 3 IVH was 1.1% in preterm infants born after 29 weeks gestation; no grade 4 IVH occurred.
- Symptomatic grade 3 IVH was observed in two infants.
- Clinical criteria poorly predicted IVH, and routine screening to detect five cases cost A$42,000.
Conclusions:
- The incidence of grade 2-4 IVH is low in infants born after 29 weeks gestation.
- Routine ultrasound screening for IVH in this population is expensive and likely not justified.
- Selective ultrasound screening based on clinical concern is recommended.
Objectives:
To determine whether the current incidence of intraventricular haemorrhage (IVH) of grade 2 or more is high enough in preterm infants born after 29 weeks gestation to justify the cost of screening with ultrasound and to explore clinical indicators for risk of IVH in the more mature preterm infant.
Methods:
This cohort study examined the incidence and severity of IVH in 800 preterm infants born between January 1992 and August 1996, of whom 436 were born after 29 weeks. Demographic and clinical details were collected from a prospectively maintained database. The Medicare schedule charge rate for cerebral ultrasound was used to calculate costs.
Results:
1.1% of preterm babies born after 29 weeks gestation who had routine ultrasound scans had an IVH of grade 2 or 3, no infant had a grade 4 IVH. Two infants had a grade 3 IVH, both of which were symptomatic. IVH was poorly predicted by other clinical criteria. Using the Medicare schedule to estimate costs, detecting the five grade 2 or 3 IVH cost A$42,000.
Conclusions:
The incidence of grade 2-4 IVH is low in infants born after 29 weeks gestation. Screening of this population is expensive and probably not justified. It may be most appropriate to scan these infants only if their condition raises concern.