Intraventricular hemorrhage on mortality and neurological outcomes in premature infants

Madhuri Kadam; Abhijeet Trivedi; Vishal Sachede

doi:10.18203/2349-3291.ijcp20240347

Authors

Madhuri Kadam K. B. Bhabha Municipal Hospital, Bandra, Mumbai, Maharashtra, India
Abhijeet Trivedi CAMC Women and Children Hospital, Charleston, West Virginia USA
Vishal Sachede Apex Hospital, Borivali West, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20240347

Keywords:

IVH, Preterm neonates, IVH severity, Early gestational age, Low birth weight

Abstract

Background: Intraventricular hemorrhage (IVH) is the commonly encountered clinical event in preterm neonates which imposes significant morbidity and mortality. Although there is a rapid advancement in the neonatal care, IVH is the common cause of neonatal intensive care units admissions. The present study was carried out to evaluate the risk factors, mortality and neurological outcomes in preterm neonates with IVH.

Methods: This was a prospective study conducted on 75 preterm neonates who were delivered before 37 weeks of gestation. The neonates were subjected to cranial ultrasound for the diagnosis of IVH and graded as per the severity. The neonatal and prenatal variables were recorded and analysed to find its association with IVH progression and mortality. Immediate neurological outcome was also assessed among the IVH preterm neonates.

Results: In this study out of 75 preterm neonates, the prevalence of IVH was 18 (24%). The main neonatal factors for IVH are less gestational age at delivery, 28-31 weeks (p=0.001), birth weight <1500 gm (p=0.001), APGAR scores <5 at 1 and 5 minutes (p>0.05) and maternal factors associated with IVH is premature rupture of membranes (p=0.01). The mortality rate among the IVH preterm neonates was 7 (38.9%). The significant predictors of mortality were male gender (p=0.004), grade III and IV IVH (p=0.001) and birth weight (p=0.001). The main neurological outcomes observed were seizures and post-hemorrhagic ventricular dilatation.

Conclusions: Increased severity of IVH, early gestational age and low birth weight were associated with mortality in preterm neonates with IVH.

Metrics

Metrics Loading ...

References

Chen X, Zhang X, Li W, Li W, Wang Y, Zhang S et al. Iatrogenic vs. Spontaneous Preterm Birth: A Retrospective Study of Neonatal Outcome Among Very Preterm Infants. Front Neurol. 2021;12:649749.

Ballabh P. Intraventricular Hemorrhage in Premature Infants: Mechanism of Disease. Pediatr Res. 2010;67(1):1-8.

Deshpande P, Jain A, Ibarra Ríos D, Bhattacharya S, Dirks J, Baczynski M et al. Combined Multimodal Cerebral Monitoring and Focused Hemodynamic Assessment in the First 72 h in Extremely Low Gestational Age Infants. Neonatology. 2020;117(4):504-12.

Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: A study of infants with birth weights less than 1,500 gm. J Pediatr. 1978;92(4):529-34.

Payne AH, Hintz SR, Hibbs AM, Walsh MC, Vohr BR, Bann CM, et al. Neurodevelopmental outcomes of extremely low-gestational-age neonates with low-grade periventricular-intraventricular hemorrhage. JAMA Pediatr. 2013;167(5):451-9.

Wu T, Wang Y, Xiong T, Huang S, Tian T, Tang J et al. Risk factors for the deterioration of periventricular-intraventricular hemorrhage in preterm infants. Sci Rep. 2020;10(1):13609.

Hong HS, Lee JY. Intracranial hemorrhage in term neonates. Child’s Nerv Syst. 2018;34(6):1135-43.

Levene MI, Starte DR. A longitudinal study of post-haemorrhagic ventricular dilatation in the newborn. Arch Dis Child. 1981;56(12):905-10.

Vollmer B, Roth S, Baudin J, Stewart AL, Neville BGR, Wyatt JS. Predictors of Long-Term Outcome in Very Preterm Infants: Gestational Age Versus Neonatal Cranial Ultrasound. Pediatrics. 2003;112(5):1108-14.

Van Beek P, Groenendaal F, Broeders L, Dijk PH, Dijkman KP, Van Den Dungen FAM et al. Survival and causes of death in extremely preterm infants in the Netherlands. Arch Dis Child Fetal Neonatal Ed. 2021;106(3):251-7.

Wang Y, Song J, Zhang X, Kang W, Li W, Yue Y et al. The Impact of Different Degrees of Intraventricular Hemorrhage on Mortality and Neurological Outcomes in Very Preterm Infants: A Prospective Cohort Study. Front Neurol. 2022;13:853417.

Gilard V, Tebani A, Bekri S, Marret S. Intraventricular Hemorrhage in Very Preterm Infants: A Comprehensive Review. J Clin Med. 2020;9(8):2447.

Hansen TWR. Prophylaxis of intraventricular hemorrhage in premature infants: New potential tools, new potential challenges. Pediatric Critical Care Medicine. 2006;7(1):90-2.

Garvey AA, Walsh BH, Inder TE. Pathogenesis and prevention of intraventricular hemorrhage. Semin Perinatol. 2022;46(5):151592.

Kersin SG. Prematürede intraventriküler kanama. Türk Pediatr Arşivi. 2020;55(3):215-21.

Patil V, Patil M, Sarawade S, Kumbhojkar S, V SK. Assessment of intraventricular haemorrhage in preterm neonates using neurosonography through anterior fontanelle‏. Int J Heal Sci Res. 2017;7(3):27-31.

Ahmed T, Baki A, Begum T, Nahar N. Clinical Presentation of Preterm Neonates with Intraventricular Hemorrhage: Experience in a Tertiary Care Hospital in Dhaka. BIRDEM Med J. 2017;7(3):194.

Adegoke S, Bankole K, Olugbemiga A, Tinuade O. Intraventricular hemorrhage in newborns weighing <1500 g: Epidemiology and short-term clinical outcome in a resource-poor setting. Ann Trop Med Public Heal. 2014;7(1):48.

Parodi A, Govaert P, Horsch S, Bravo MC, Ramenghi LA. Cranial ultrasound findings in preterm germinal matrix haemorrhage, sequelae and outcome. Pediatr Res. 2020;87(S1):13-24.

Jashni Motlagh A, Elsagh A, Sedighipoor E, Qorbani M. Risk factors and short-term complications of high-grade intraventricular hemorrhages in preterm neonates in training hospitals of Alborz. Iran J child Neurol. 2021;15(1):47-55.

Egwu CC, Ogala WN, Farouk ZL, Tabari AM, Dambatta AH. Factors associated with intraventricular hemorrhage among preterm neonates in Aminu Kano teaching hospital. Niger J Clin Pract. 2019;22(3):298-304.

Tadasa S, Tilahun H, Melkie M, Getachew S, Debele GR, Bekele F. Magnitude and associated factors of intraventricular hemorrhage in preterm neonates admitted to low resource settings: a cross-sectional study. Ann Med Surg. 2023;85(6):2534-9.

Zhao Y, Zhang W, Tian X. Analysis of risk factors of early intraventricular hemorrhage in very-low-birth-weight premature infants: a single center retrospective study. BMC Pregnancy Childbirth. 2022;22(1):890.

Guillet A, Wilson-Smith MR, Caughey AB. Outcomes of Neonates From Pregnancies With Preterm Premature Rupture of Membranes [313]. Obstet Gynecol. 2015;125(1):100S.

Kashaki M, Saboute M, Allafi ME, Norouzi E. Is Maternal Hypertension a Reducing Factor for Intraventricular Hemorrhage in Iranian Preterm Newborns? Int J Pediatr. 2022;10(8):16469-76.

Spagnoli C, Falsaperla R, Deolmi M, Corsello G, Pisani F. Symptomatic seizures in preterm newborns: a review on clinical features and prognosis. Ital J Pediatr. 2018;44(1):115.

Tioseco JA, Aly H, Essers J, Patel K, El-Mohandes AAE. Male sex and intraventricular hemorrhage. Pediatr Crit Care Med. 2006;7(1):40-4.

Piccolo B, Marchignoli M, Pisani F. Intraventricular hemorrhage in preterm newborn: Predictors of mortality. Acta Biomed. 2022;93(2):e2022041.

Klebe D, MBride D, Krafft PR, Flores JJ, Tang J, Zhang JH. Posthemorrhagic hydrocephalus development after germinal matrix hemorrhage: Established mechanisms and proposed pathways. J Neurosci Res. 2020;98(1):105-20.