Risk factor analysis of intraventricular hemorrhagein low-birth-weight infants

doi:10.1016/S0022-3476(81)80276-4

The Journal of Pediatrics

Volume 99, Issue 4, October 1981, Pages 625-628

https://doi.org/10.1016/S0022-3476(81)80276-4 Get rights and content

Sixty of 63 newborn infants weighing less than 1,250 gm, admitted consecutively to the Intensive CareNursery during a 15-month period, were prospectively investigated for the incidence of intraventricular hemorrhage by early computerized tomography, or by autopsy. Nineteen of the 60 infants had evidence of IVH. The incidence of IVH was correlated with the presence of possible neonatal, obstetrical, asphyxial, or therapeutic risk factors. There was a significant difference in only one of the risk factors: birth outside the perinatal center. Fifteen of 27 outborn infants (56%) developed IVH, whereas only four of 33 inborn infants (12%) developed IVH (P<0.001). There were no statistically significant differences in maternal obstetrical risk factors, infant risk factors, or indices of birth asphyxia in the inborn compared with the outborn infants. However, perinatal therapeutic risk factors differed between the two groups. Outborn infants were less likely to have received betamethasone (P<0.001), were less likely to have their arterial blood gases monitored and stabilized during the first 20 minutes after birth (P<0.001), and were given more bicarbonate (P<0.001) and more boluses of fluid intravenously (P<0.02). The risk of IVH in, very low birth-weight infants may be significantly decreased by therapeutic factors at birth. Maternal transport to a perinatal center and intensive neonatal resuscitation may contribute to decreasing the incidence of intraventricular hemorrhage.

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Cited by (77)

Intraventricular Hemorrhage in Premature Infants: A Historical Review
2021, World Neurosurgery
Citation Excerpt :
A landmark study in 1972 demonstrated that antenatal corticosteroid therapy reduced respiratory distress syndrome incidence and mortality.17 A study in 1981 observed a 0.28 relative risk for IVH with perinatal betamethasone treatment, with betamethasone reducing severity of hyaline membrane disease.18 Prenatal steroids became part of the American College of Obstetrics and Gynecology guidelines in women between 24 and 34 weeks considered to be at risk for preterm delivery within 7 days.19
Intraventricular hemorrhage (IVH) is common in premature newborns and poses a high risk for morbidity with lifelong disability. We searched the available literature for original and secondary literature regarding the epidemiology, pathogenesis, and treatment of IVH in order to trace changes in the management of this disease over time.
We examined IVH pathogenesis and epidemiology and reviewed the history of medical and surgical treatment for intraventricular hemorrhage in preterm children. Initial medical management strategies aimed at correcting coagulopathy and eventually targeted mediators of perinatal instability including respiratory distress. Surgical management centered around cerebrospinal fluid diversion, initially through serial lumbar punctures, progressing to ventriculoperitoneal shunting, with more recent interventions addressing intraventricular clot burden.
We provide a historical review of the evolution of treatment for IVH in newborns. While the management of IVH has grown significantly over time, IVH remains a common neurosurgical disease that continues to affect patient and caregiver quality of life and health care costs. Despite advances in treatment over more than a century, IVH remains a significant cause of morbidity and mortality in premature infants, and an understanding of past approaches may inform the development of new treatments.
Preterm Intraventricular Hemorrhage/Posthemorrhagic Hydrocephalus
2018, Volpe's Neurology of the Newborn
Germinal matrix hemorrhage–intraventricular hemorrhage (GMH-IVH) is the most common variety of neonatal intracranial hemorrhage and is characteristic of the premature infant. This form of brain injury affects around 25% of all very low birthweight (<1500 g) premature infants, resulting in an increased risk for neurodevelopmental disability. Its occurrence can lead to impact on subsequent brain development because of destruction of the immature germinal cerebral region resulting in loss of progenitor cells, acceleration of white matter injury via pressure and oxidative stress, and direct parenchymal injury. Finally, hydrocephalus can complicate IVH, resulting in a further increased risk of neurodevelopmental disability. In this chapter, the neuropathology, pathogenesis, clinical features, diagnosis, prognosis, and management of IVH, and its complications will be reviewed. The prominent position of this lesion in neonatal medicine has been accompanied by a large increase in work from several disciplines. This chapter attempts to integrate this information in a meaningful way without oversimplifying a clearly complex problem.
The effect of transport on the rate of severe intraventricular hemorrhage in very low birth weight infants
2000, Obstetrics and Gynecology
Objective: To determine the incidence of grade III or IV intraventricular hemorrhage in very low birth weight (VLBW) infants born at level I hospitals and transported to one tertiary center compared with those delivered at the same level III facility.
Methods: We evaluated all newborns admitted to a large tertiary neonatal intensive care unit from June 1, 1992, through December 31, 1995. All live born infants with birth weights of 500–1200 g and at least 24 weeks’ gestation were included. Neonatal transports within 24 hours of delivery from 11 level I facilities were compared with those delivered at the same level III center with respect to grade III and IV intraventricular hemorrhage. Various antenatal and neonatal data were collected.
Results: Thirty-seven newborns (11%) experienced grade III or IV intraventricular hemorrhages among 329 who met study criteria. There were 27 cases (9%) in the 285 inborn neonates compared with 10 of 44 outborn cases (23%) (P < .02, 95% confidence interval 0.15, 0.87). The mean gestational age of the neonates with grade III or IV intraventricular hemorrhages was significantly lower in the inborn group, which further emphasizes the finding. No other study factors explained the difference.
Conclusion: We found a higher risk for grade III or IV intraventricular hemorrhage developing in VLBW infants born at level I hospitals and transported to the tertiary care center compared with those born at the level III facility. This data should be considered when analyzing the potential effects of perinatal deregionalization.
Epidemiology of common neurosurgical diseases in the neonate
1998, Neurosurgery Clinics of North America
This article reviews the epidemiology and risk factors of posthemorrhagic hydrocephalus and neural tube defects (NTDs). Posthemorrhagic hydrocephalus is discussed in terms of risk factors for intraventricular hemorrhage. Four categories of risk factors are presented: maturational factors, antepartum factors, peripartum factors, and factors conferred by postnatal conditions. The complex epidemiology of neural tube defects is discussed in terms of person, place, and time. Interventional strategies, including antenatal screening and nutritional supplementation for NTD prevention, are reviewed.
Intraventricular hemorrhage in the preterm infant
1996, Early Human Development
Intraventricular hemorrhage (IVH) is a common neonatal morbidity among premature infants which is diagnosed by cranial ultrasound in the newborn special care unit. Although very premature infants are more likely to experience the highest grades of hemorrhage, a number of perinatal and postnatal events have been shown to be associated with it's occurence. Factors such as vaginal delivery, labor, and intrapartum asphyxia have been associated with early onset of hemorrhage, whereas antenatal exposure to steroids may be protective. Respiratory Distress Syndrome has also been associated with hemorrhage. Since infants with a history of IVH have increased mortality rates and are at increased risk of seizures, periventricular leukomalacia, hydrocephalus, and neurodevelopmental handicap, many investigators have studied management techniques and pharmacologic interventions to decrease the incidence of IVH, including muscle paralysis, phenobarbital, Vitamin E, indomethacin, ethamsylate and surfactant. Our investigations have shown that low dose indomethacin (0.1 mg/kg i.v.) at 6–12 postnatal hours and every 24 h for two more doses decreases the incidence of all grades of IVH within the first 5 days of life. Although tremendous progress has been made in the understanding of the pathogenesis and prevention of IVH, innovative animal and human studies are needed to further reduce the incidence of this important neonatal morbidity.
Parental Interventions and the Development of the Preterm Infant
1994, Journal of Obstetric, Gynecologic, & Neonatal Nursing

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Risk factor analysis of intraventricular hemorrhagein low-birth-weight infants

J Pediatr

Am J Obstet Gynecol

J Pediatr

J Pediatr

Haemorrhage, ischemia, and the perinatal brain

Clinical predictability of intraventricular hemorrhage in preterm infants

Pediatrics

Neonatal intracranial hemorrhage-iatrogenic etiology

N Engl J Med

Certain causes of neonatal death. II. Intraventricular hemorrhage

Biol Neonate

Neonatal intracranial hemorrhage: Pathophysiology, neuropathology and clinical features

Clin Perinatol

Pathogenesis of intraventricular haemorrhage in newborn infants

Arch Dis Child