Predictors of Intraventicular Hemorhage in the Neonatal Intensive Care Unit
1İstinye University Faculty of Medicine Antalya Medical Park Hospital, Department of Pediatrics, Division of Neonatology, Antalya, Turkey
2University of Health Sciences, Antalya Research and Training Hospital, Department of Pediatrics, Division of Neonatology, Antalya, Turkey
J Crit Intensive Care 2021; 12(1): 1-7 DOI: 10.37678/dcybd.2021.2583
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Aim: To analyze intraventricular hemorrhage (IVH) incidence, clinical features and risk factors in extremely low birth weight infants.
Materials and Method(s): It is a single-center, retrospective cohort in infants delivering neonatal intensive care between 2010 and 2019. Infants of birth weight <1000 grams who had transfontanel-ultrasounds in the first week of life were included. Postnatal transfers, central nervous system anomalies, antenatal-diagnosed hemorrhage, death before obtaining transfontanel-ultrasound and incomplete dataset were excluded from the study. Infants were categorized as mild IVHs (grades 1-2), severe IVHs (grade-3, periventricular-hemorrhagic infarct) and control group. Ante-perinatal characteristics, clinical and laboratory features were recorded. SPSS-23 program utilized analysis for three groups.
Results: Overall IVH incidence was 22.9% in 455 neonates (52.9%, 49%, 31.5%, 13.4%, 6.7% at ≤25, 26, 27, 28 and 29 gestational weeks. Seizure was the first sign in 32.7% of the infants. Neonatal resuscitation, umbilical-cord blood pH, chorioamnionitis, patent ductus arteriosus were associated with developing mild IVH, but did not influence the progression to severe hemorrhage (p=0.782, p=0.109, p=0.566, p=0.111). Gestational age, invasive mechanical ventilation, inotrope-required hypotension was related to high-grade IVHs (p<0.001, p=0.025, p=0.013). The predictive strength of platelets to define IVH was poor at intensive care admission (sensitivity: 74%, specificity: 68.3%). Inotrope-required hypotension and low-umbilical-cord blood pH were determined as independent risk factors of high-grade IVHs (OR: 6.678, 95% CI: 2.557-17.443 and OR: 3.554, 95%CI: 1.089–11.602). Four infants necessitated ventriculo-peritoneal shunting. Mortality was 23.1% in infants developing IVH.
Conclusion: Inotrope-required hypotension is the strongest predisposing factor for high-grade ventricular hemorrhage in extremely low birth weight infants.