European Journal of Obstetrics & Gynecology and Reproductive Biology
Peri/intraventricular haemorrhage: a cranial ultrasound study on 5286 neonates
Introduction
The successful reduction of perinatal mortality almost to the optimal attainable level has meant that mortality has become less significant as a measure of the quality of obstetric care (Perinatal Statistics-Hessen, 1989). Instead infant morbidity, i.e. degree of asphyxia during birth, clinical condition post-partum, brain damage as well as neurological and mental development throughout childhood and adolescence must be taken into closer consideration when assessing standards of perinatal management.
Even with expert analysis of the cardiotocogram, acid-base status and clinical condition of the infant post-partum, the probability of cerebral damage is still very difficult to estimate 1, 2, 3, 4, 5. This problem, which often becomes the focus of lawsuits and conflicting opinions, essentially arises from a lack of concrete data. For instance, prospective studies with large patient populations are needed to investigate the relation between risk factors arising during pregnancy, birth and post-partum and the occurrence of brain damage, such as peri- or intraventricular haemorrhage in newborns 3, 4, 5, 6.
To examine the incidence and severity of cerebral morbidity in neonates systematically, the Departments of Paediatrics as well as of Obstetrics and Gynaecology at the Justus-Liebig University in Giessen collaborated in launching a prospective cranial ultrasound study of all infants born there between 1984 and 1988. The results of these examinations were related to obstetric data and procedures. Attention was focused on the correlation of these factors to the incidence of peri- and intraventricular haemorrhages (PIVH), since these are by far the most common forms of brain damage.
The present study was limited to neonates born in the Department of Obstetrics and Gynaecology of the University of Giessen so that it can be assumed that the obstetric and paediatric care of the infants was constant over the period mentioned. Some preliminary results have already been published elsewhere [7].
Section snippets
Materials and methods
From 1984 to 1988, a cranial ultrasound study was carried out on all live-born infants on the day of discharge of the mother (5–8 days post-partum) from the Department of Obstetrics and Gynaecology at the University of Giessen. Infants who had to be transferred to the Children's Hospital directly post-partum were screened in the neonate ward there. Some of the infants with abnormal findings were then monitored daily.
Results
Of the 5799 live-born babies delivered between 1984 and 1988, 5286 (91.1%) neonates (51.1% male, 48.9% female) underwent cranial ultrasound screening. In 38 babies gestational age could not be assessed. The basic obstetric data for the neonates and the distribution of the various modes of delivery and of the obstetric risk factors are given in Table 1Table 2, Table 3.
Pathological findings revealed by cerebral ultrasound screening are shown in Table 4. The most common abnormalities (3.6%) were
Discussion
The prospective cranial ultrasound study presented here is an example of successful collaboration between obstetricians and paediatricians to investigate the incidence and severity of PIVH and other pathological findings in neonates in a large, unselected population and to relate these findings to risk factors arising during pregnancy and delivery.
References (33)
- et al.
Risk factors for early intraventricular hemorrhage in low birth weight infants
J Pediatr
(1992) - et al.
The predictive value of intrapartum fetal heart rate abnormalities in the extremely premature infant
Am J Obstet Gynecol
(1994) - et al.
Antenatal risk factors for germinal matrix hemorrhage and intraventricular hemorrhage in preterm infants
Eur J Obstet Gynecol Reprod Biol
(1995) - et al.
Sonographic classification of intraventricular hemorrhage. A prognostic indicator of mortality, morbidity, and short-term neurologic outcome
J Pediatr
(1982) - et al.
Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weight less than 1500 g
J Pediatr
(1978) - et al.
Neonatal germinal matrix hemorrhage: evidence of a progressive lesion
J Pediatr
(1981) - et al.
Periventricular intraventricular hemorrhage
Pediatr Clin North Am
(1986) - et al.
Prevention of intraventricular hemorrhage in preterm infants by pentobarbitone
Lancet
(1981) - et al.
Clinical predictability of intraventricular hemorrhage in preterm infants
Pediatrics
(1980) - et al.
Zur Frühprognose der intrakraniellen Blutung bei Frühgeborenen
Monatsschr Kinderheilk
(1986)