Early Vital Sign Differences in Very Low Birth Weight Infants with Severe Intraventricular Hemorrhage

Abstract

Objective Severe intraventricular hemorrhage (sIVH, grades 3 and 4) is a serious complication for very low birth weight (VLBW) infants and is often clinically silent requiring screening cranial ultrasound (cUS) for detection. Abnormal vital sign (VS) patterns might serve as biomarkers to identify risk or occurrence of sIVH. Study Design This retrospective study was conducted in VLBW infants admitted to two level-IV neonatal intensive care units (NICUs) between January 2009 and December 2018. Inclusion criteria were: birth weight <1.5 kg and gestational age (GA) <32 weeks, at least 12 hours of systemic oxygen saturation from pulse oximetry (SpO2) data over the first 24 hours and cUS imaging. Infants were categorized as early sIVH (sIVH identified in the first 48 hours), late sIVH (sIVH identified after 48 hours and normal imaging in the first 48 hours), and no IVH. Infants with grades 1 and 2 or unknown timing IVH were excluded. Mean heart rate (HR), SpO2, mean arterial blood pressure (MABP), number of episodes of bradycardia (HR < 100 bpm), and desaturation (SpO2 < 80%) were compared. Results A total of 639 infants (mean: 27 weeks' gestation) were included (567 no IVH, 34 early sIVH, and 37 late sIVH). In the first 48 hours, those with sIVH had significantly higher HR compared with those with no IVH. Infants with sIVH also had lower mean SpO2 and MABP and more desaturations <80%. No significant differences in VS patterns were identified in early versus late sIVH. Logistic regression identified higher HR and greater number of desaturations <80% as independently associated with sIVH. Conclusion VLBW infants who develop sIVH demonstrate VS differences with significantly lower SpO2 and higher mean HR over the first 48 hours after birth compared with VLBW infants with no IVH. Abnormalities in early VS patterns may be a useful biomarker for sIVH. Whether VS abnormalities predict or simply reflect sIVH remains to be determined. Key Points

Clinical Application of Microsurgery Using the Cerebellar Medulla Fissure Approach in Severe Ventricular Hemorrhage with Casting of the Fourth Ventricle and Its Influence on Neurological Recovery

“…In many patients, spontaneous intracerebral hemorrhage is caused by nontraumatic factors, and their mortality and disability rates are extremely high [ 1 – 3 ]. If an intracerebral hemorrhage breaks into the ventricle, it may quickly lead to a rapid increase in intracranial pressure, acute dilation of the ventricle, and compression of the ventricle system by a hematoma, resulting in acute obstructive hydrocephalus [ 4 , 5 ]. These patients will develop critical disease quickly, with rapid onset, rapid progression, high mortality, and poor prognosis [ 6 ].…”

Machine Learning Detects Intraventricular Haemorrhage in Extremely Preterm Infants

“…In terms of absolute values, Vesoulis et al [ 43 ] studied 645 infants born <32 weeks of GA and proposed that the time spent with SpO 2 ≤ 70% was associated with severe grade III and IV IVH. Moreover, a lower level of SpO 2 was associated with IVH grades III and IV in very low birth weight infants [ 44 ]. However, in the current study, we did not find an association between features extracted from the SpO 2 signal, including and excluding PRDs or with time spent below SpO 2 ≤ 85%, with IVH outcome.…”

Heart Rate and Pulse Oximetry Dynamics in the First Week after Birth in Neonatal Intensive Care Unit Patients and the Risk of Cerebral Palsy

“…Low SD of HR values displayed on standard NICU monitors is a simple measurement of HR variability, whereas the more traditional measure of HRV is SD of interheartbeat intervals which requires analysis of QRS complexes from the electrocardiogram waveform. We and others have reported low HRV to be associated with acute brain injury in both term and preterm neonates 9 11 16 18 19 27 and one aim of the current work was to discover simple metrics which do not require waveform analysis. In addition to low HR SD, negative skewness of HR was retained in the final CP model likely reflecting the fact that HR decelerations can be associated with pathology.…”

“…8,9,16 In subsequent work, we reported that preterm infants with severe intraventricular hemorrhage (IVH) have lower HR variability for several weeks after birth compared with those with no or low-grade IVH, perhaps reflecting chronic neuroinflammation. 18,19 In those studies, HR variability analysis was performed by analyzing electrocardiogram QRS complexes and using various measurements such as standard deviation (SD) of interbeat intervals. Since R peak detection in electrocardiogram is not readily available, our recent research has utilized a simpler method of analyzing the SD of the HR displayed on NICU bedside monitors, as well as the SpO 2 from the pulse oximeter.…”