Improving incidence trends of severe intraventricular haemorrhages in preterm infants <32 weeks gestation: a cohort study

Abstract

ObjectiveTo describe the trend and risk factors for severe intraventricular haemorrhage (IVH) among infants &lt;32 weeks gestation.DesignPopulation-based cohort study.SettingAustralia and New Zealand.PatientsAll preterm infants &lt;32 weeks gestation in the Australian and New Zealand Neonatal Network (ANZNN) from 1995 to 2012.InterventionsComparison of IVH incidence between 6-year epochs.Main outcome measuresOverall IVH and severe IVH incidence.ResultsA total of 60 068 infants were included, and overall survival to discharge increased from 89% to 93% over the three epochs. As the percentage of infants with IVH decreased from 23.6% to 21.3% and 21.4% (p&lt;0.001) from epoch 1 to 3, respectively, fewer survivors had severe IVH (4.0%, 3.3% and 2.8%, respectively, p&lt;0.001). Over time, there were fewer antenatal complications, higher antenatal steroid usage and more caesarean-section births. Fewer infants were intubated at birth, had low 5 min Apgar score, had sepsis or pneumothorax needing drainage. Adjusted for perinatal confounders, there was significant reduction in odds of severe IVH from epoch 1 to 3 (adjusted OR (AOR) 0.8, 95% CI 0.7 to 0.9). Factors associated with development of severe IVH include no antenatal steroids (AOR 1.7, 95% CI 1.5 to 1.9), male (AOR 1.3, 95% CI 1.2 to 1.4), 5 min Apgar score &lt;7 (AOR 2.0, 95% CI 1.9 to 2.2), intubated at birth (AOR 2.0, 95% CI 1.8 to 2.2), extremely low gestational age (AOR 4.0, 95% CI 3.7 to 4.4), outborn (AOR 1.6, 95% CI 1.5 to 1.8) and vaginal delivery (AOR 1.4, 95% CI 1.3 to 1.6).ConclusionsAlong with increased survival among infants born &lt;32 weeks gestation, the incidence of severe IVH has decreased over the 18 years, especially in the most recent period. This coincided with reduction in rates of risk factors for severe IVH development.

Cerebral Oxygenation and Autoregulation in Very Preterm Infants Developing IVH During the Transitional Period: A Pilot Study

“…GMH-IVH infants had a significantly lower GA and Apgar score compared to controls. This is consistent with previous data investigating the predictive risk factors for GMH-IVH development (22,23). Although an inverse correlation between TOHRx and GA has been previously reported (12), in the present study the between-group difference was observed only before, and not after GMH-IVH development.…”

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

“…Overall and in all subgroups of weight and gestation for any IVH and high grade IVH, our rates of IVH are higher than those reported in HICs. The difference is smallest in the <1500g and <28 week gestation groups and largest in babies weighing >1500g or >37 weeks, suggesting in our setting it could be the higher weight and later gestation babies that could bene t most from modi cation of risk factors (13)(14)(15)(16)26) .…”

“…When assessed by GA, of those born at <28 weeks GA, 32-33.9% have IVH, 12.6-16% severe (13,15). More mature neonates born at <32 weeks have reported IVH prevalence of 21.4-23.1% (14,16). In HICs, high grade IVH leads to cerebral palsy in about 30% of cases, mainly but not only related to the site of parenchymal haemorrhagic infarction, in addition to other developmental and neurosensory impairments (15).…”

Review of guidelines and recommendations from 17 countries highlights the challenges that clinicians face caring for neonates born to mothers with COVID‐19

“…The respiratory management and treatment of infants born to mothers with COVID-19 is another consideration. Antenatal steroids decrease the risk of adverse preterm infant outcomes, [75][76][77] but may also pose a theoretical risk of worsening maternal viraemia. 78,79 Conversely, steroids reduce the cytokine storm, especially if maternal acute respiratory distress syndrome is evident.…”