1381 Association of Perinatal Factors With Periventricular Hemorrhage (Pvh) in Very Low Birthweight (Vlbw) Neonates

Abstract

1384 F i n e r , Kathrine P e t e r s , Keith Barrington, 2 5Havek.Universi t v of A1 b e r t a . Roval A1 exandra of P e d i a t r i c s . Hal i f a x . N.S. In an e f f o r t t o i d e n t i f v r i s k f a c t o r s associated with t h e ------ Perinatal f a c t o A ' a s s o c i a t e d with PVH were ~r o s D e c t i v e l yd e v e l o~m e n t of bronchopulm~nary dysplasia (BPD) we retrospecsurveyed i n 157 consecutively born VLBW i n b o r n ' i n f a n t s .Diagnosis of PVH was determined by cranial ultrasound (148 c a s e s ) o r autopsy ( 9 c a s e s ) . Ten i n f a n t s with major anomalies and four i n f a n t s who had no ultrasound o r autopsy were excluded. The o v e r a l l incidence of PVH was 29.9%, 22.9% minor (Gr 1-2) and 7% major (Gr 3-4). Mean gest age (GA) and birthweight (BW) were s i g n i f i c a n t l y lower (p<0.001) i n those who developed PVH: 974+227g and 27f2.6 wk vs 1150f269g and 30f3.3 wk r e s p e c t i v e l y . Mortality was 13.6% i n i n f a n t s with no PVH, 22.2% with minor, and 45.5% with major PVH. With p a r t i a l c o r r e l a t i o n a n a l y s i s , highly s i g n i f i c a n t (p<0.001) perinatal f a c t o r s found t o be independently associated with PVH were vaginal d e l i v e r y , hyal ~n e membrane disease (HMD), p o s i t i v e pressure v e n t i l a t i o n (PPV) and pneumothorax. The reduced incidence of PVH associated with Caesarean s e c t i o n (CS) was noted only i n i n f a n t s (30 wk GA.Major PVH occurred exclusively i n i n f a n t s who had no o r suboptimal (<24 h r ) prenatal s t e r o i d s (p<0.03), developed severe HMD (p<0.001) and required PPV (p<0.001) .In attempting t o reduce the incidence and s e v e r i t y of PVH, a t t e n t i o n should be focused on t h e prevention of prematurity and HMO. The suggestion t h a t CS prevents PVH i n extremely premature i n f a n t s could be e s t a b l i s h e d only with a randomized c o n t r o l l e d t r i a l .Post n a t a l (PN) evolution of anthropometric v a r i a b l e s ( A V ) i n preterm i n f a n t s ( P I ) f e d b r e a s t milk (BM). 2,4 wks, BW : 1323' 3 t 255 9: They were followed during 3 t o 10 weeks measuring'each week, head and chest circumferences ( H C , C C ) , midark circumference (MAC), t r i c e p s skinf o l d thickness (TSKF) derived arm muscle and f a t a r e a s (AMA,AFA). C o r r e l a t i o n s were mad; between GA and AV, and then compared wlth f e t u s values, (oreviously described on 74 AGA and 22 SGA a t d I d l i f e ) a s follows : t i v e l y ' reviewed over a 5 y e a r period the neonatal course of a l l 188 i n f a n t s of <I500 g who required mechanical v e n t i l a t i o n f o r >24 hours and survived a t l e a s t 14 days.I n f a n t s with BPO had lower b i r t h weights ( p < .001), s h o r t e r g e s t a t i o n s ( p <.001), more frequent patent ductus a r t e r i o s u s (p=.009), more often required muscle r e l a x a t i o n ( p <.001), had i n t e r s t i t i a l a i r on x-ray within 7 days of b i r t h (p=.007). A d i s c r i m i n a...