Delivery mode and intraventricular hemorrhage risk in very-low-birth-weight infants: Observational data of the German Neonatal Network

Humberg, Alexander; Härtel, Christoph; Paul, Pia; Hanke, Kathrin; Bossung, Verena; Hartz, Annika; Fasel, Laura; Rausch, Tanja K.; Rody, Achim; Herting, Egbert; Göpel, Wolfgang

doi:10.1016/j.ejogrb.2017.03.032

Cited by 65 publications

(46 citation statements)

References 33 publications

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“…Recent studies found a reduced risk of IVH when the mother had entered into labor prior to CS [22]. Only 4 of the PE mothers in our study were in labor before CS, and we were thus not able to ascertain possible effects of the delivery mode on the development of IVH.…”

Section: Discussioncontrasting

confidence: 39%

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Reduced Prevalence of Severe Intraventricular Hemorrhage in Very Preterm Infants Delivered after Maternal Preeclampsia

2018

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Background: Very preterm (VPT) delivery after severe preeclampsia (PE) has been associated with adverse perinatal outcome. It is unclear whether fetal exposure to PE per se modifies the prevalence of neonatal morbidities associated with VPT birth. Objectives: To evaluate neonatal morbidity in VPT infants exposed to maternal PE compared to morbidity in nonexposed VPT infants. Methods: This retrospective study consisted of all inborn infants delivered before 30 gestational weeks admitted to a tertiary-level neonatal intensive care unit between 1998 and 2014: 195 infants exposed to maternal PE were compared to 957 infants without maternal PE (background group). Prevalence rates of neonatal morbidity, cerebral palsy (CP), and mortality at 2 years of age were obtained from patient records. Results: The PE group had a lower median (IQR) birth weight (795 [262] g) and a higher median gestational age (GA) (27 [3] weeks) at birth than the background group (890 [385] g and 26 [3] weeks, respectively; both p < 0.001). Exposure to maternal PE was associated with lower rates of severe intraventricular hemorrhage (IVH) (2 vs. 11%), retinopathy of prematurity requiring treatment (2 vs. 7%), mortality (9 vs. 15%), and CP (4 vs. 8%). Exposure to PE remained associated with a reduced prevalence of severe IVH (OR 0.17, 95% CI 0.05–0.57) after adjustment for GA, multiple birth, Apgar score, delivery mode, sex, and antenatal steroid treatment. Conclusion: Fetal exposure to PE is associated with a decreased rate of severe IVH following VPT birth. Studies on underlying mechanisms may provide a basis for prevention of IVH in the VPT infant.

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Section: Discussioncontrasting

confidence: 39%

“…Data on the incidence of IVH in relation to mode of delivery are inconsistent [21,22]. Recent studies found a reduced risk of IVH when the mother had entered into labor prior to CS [22].…”

Section: Discussionmentioning

confidence: 99%

Reduced Prevalence of Severe Intraventricular Hemorrhage in Very Preterm Infants Delivered after Maternal Preeclampsia

2018

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“…It was not shown to be associated with low grade IVH, however the sample was too small to determine the relationship with high grade IVH when adjusted for GA, sex and weight. Whilst vaginal delivery is a recognised risk factor for high grade IVH in HICs, this nding has not been replicated in studies from LICs in sub-Saharan Africa (9,10,12,29,30) . This may be related to the timing and indication for Caesarean differing.…”

Section: Risk Factorsmentioning

confidence: 96%

Intraventricular haemorrhage in a Ugandan cohort of low birth weight neonates: The IVHU study

MacLeod

Paulson²,

Okalany

et al. 2020

Preprint

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Background Globally, 15 million neonates are born prematurely every year, over half in low income countries (LICs). Premature and low birth weight neonates have a higher risk of intraventricular haemorrhage (IVH). There are minimal data regarding IVH in sub-Saharan Africa. This study aimed to examine the incidence, severity and timing of and modifiable risk factors for IVH amongst low-birth-weight neonates in Uganda.Methods This is a prospective cohort study of neonates with birthweights of ≤2000g admitted to a neonatal unit (NNU) in a regional referral hospital in eastern Uganda. Maternal data were collected from interviews and medical records. Neonates had cranial ultrasound (cUS) scans on the day of recruitment and days 3, 7 and 28 after birth. Risk factors were tabulated and are presented alongside odds ratios (ORs) and adjusted odds ratios (aORs) for IVH incidence. Outcomes included incidence, timing and severity of IVH and 28-day survival. Results Overall, 120 neonates were recruited. IVH was reported in 34.2% of neonates; 19.2% had low grade (Papile grades 1-2) and 15% had high grade (Papile grades 3-4). Almost all IVH (90.2%) occurred by day 7, including 88.9% of high grade IVH. Of those with known outcomes, 70.4% (81/115) were alive on day 28 and survival was not associated with IVH. We found that vaginal delivery, gestational age (GA) <32 weeks, resuscitation in the NNU and being small for gestational age (SGA, <10th centile) increased the odds of IVH. Of the 6 neonates who received 2 doses of antenatal steroids, none had IVH. Conclusion In this resource limited NNU in eastern Uganda, more than a third of neonates born weighing ≤2000g had an IVH and the majority of these occurred by day 7. We found that vaginal birth, earlier gestation, being SGA and need for resuscitation after admission to the NNU increased the risk of IVH. This study had a high rate of SGA neonates and the risk factors and relationship of these factors with IVH in this setting needs further investigation. The role of antenatal steroids in the prevention of IVH in LICs also needs urgent exploration.

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“…Zum optimalen Entbindungsmodus an der Grenze der Lebensfähigkeit liegen naturgemäß kaum randomisierte Daten vor und die Ergebnisse der publizierten Studien sind widersprüchlich [47][48][49][50][51][52][53]. Einzelne Studien scheinen einen Vorteil in bezug auf Mortalität und Hirnblutungsrate durch Kaiserschnittentbindung nahezulegen [47][48][49][50][51], andere finden keinen Unterschied [52,53]. Letztendlich muss der optimale Entbindungsmodus individuell festgelegt werden.…”

Section: Geburtsmodusunclassified

Update: Erstversorgung von Frühgeborenen an der Grenze der Lebensfähigkeit

Berger

Kiechl‐Kohlendorfer

Berger

et al. 2018

Monatsschr Kinderheilkd

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Delivery mode and intraventricular hemorrhage risk in very-low-birth-weight infants: Observational data of the German Neonatal Network

Cited by 65 publications

References 33 publications

Reduced Prevalence of Severe Intraventricular Hemorrhage in Very Preterm Infants Delivered after Maternal Preeclampsia

Reduced Prevalence of Severe Intraventricular Hemorrhage in Very Preterm Infants Delivered after Maternal Preeclampsia

Intraventricular haemorrhage in a Ugandan cohort of low birth weight neonates: The IVHU study

Update: Erstversorgung von Frühgeborenen an der Grenze der Lebensfähigkeit

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