RT Journal Article
SR Electronic
T1 Improving incidence trends of severe intraventricular haemorrhages in preterm infants <32 weeks gestation: a cohort study
JF Archives of Disease in Childhood - Fetal and Neonatal Edition
JO Arch Dis Child Fetal Neonatal Ed
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP 145
OP 150
DO 10.1136/archdischild-2018-316664
VO 105
IS 2
A1 Kee Thai Yeo
A1 Reji Thomas
A1 Sharon SW Chow
A1 Srinivas Bolisetty
A1 Ross Haslam
A1 William Tarnow-Mordi
A1 Kei Lui
A1 ,
YR 2020
UL http://fn.bmj.com/content/105/2/145.abstract
AB Objective To describe the trend and risk factors for severe intraventricular haemorrhage (IVH) among infants <32 weeks gestation.Design Population-based cohort study.Setting Australia and New Zealand.Patients All preterm infants <32 weeks gestation in the Australian and New Zealand Neonatal Network (ANZNN) from 1995 to 2012.Interventions Comparison of IVH incidence between 6-year epochs.Main outcome measures Overall IVH and severe IVH incidence.Results A total of 60 068 infants were included, and overall survival to discharge increased from 89% to 93% over the three epochs. As the percentage of infants with IVH decreased from 23.6% to 21.3% and 21.4% (p<0.001) from epoch 1 to 3, respectively, fewer survivors had severe IVH (4.0%, 3.3% and 2.8%, respectively, p<0.001). Over time, there were fewer antenatal complications, higher antenatal steroid usage and more caesarean-section births. Fewer infants were intubated at birth, had low 5 min Apgar score, had sepsis or pneumothorax needing drainage. Adjusted for perinatal confounders, there was significant reduction in odds of severe IVH from epoch 1 to 3 (adjusted OR (AOR) 0.8, 95% CI 0.7 to 0.9). Factors associated with development of severe IVH include no antenatal steroids (AOR 1.7, 95% CI 1.5 to 1.9), male (AOR 1.3, 95% CI 1.2 to 1.4), 5 min Apgar score <7 (AOR 2.0, 95% CI 1.9 to 2.2), intubated at birth (AOR 2.0, 95% CI 1.8 to 2.2), extremely low gestational age (AOR 4.0, 95% CI 3.7 to 4.4), outborn (AOR 1.6, 95% CI 1.5 to 1.8) and vaginal delivery (AOR 1.4, 95% CI 1.3 to 1.6).Conclusions Along with increased survival among infants born <32 weeks gestation, the incidence of severe IVH has decreased over the 18 years, especially in the most recent period. This coincided with reduction in rates of risk factors for severe IVH development.