Peri-intraventricular hemorrhage in newborns weighing less than 1500 grams: comparative analysis between 2 institutions

Abstract

PURPOSE:This study aims to characterize the peri-intraventricular hemorrhages in the neonatal period in very low birth weight newborns in 2 institutions that provide neonatal tertiary assistance.METHOD: This was a comparative and observational study in 2 neonatal intensive care units, the Maternity Hospital of Campinas and the "Centro de Atenção Integrada à Saúde da Mulher" of the State University of Campinas, from December 01, 1998 to November 30, 1999. We examined 187 newborns for peri-intraventricular hemorrhages, using transfontanel ultrasound (76 and 11 respectively at the first and second unit), and classified them into 4 grades. We observed their gender, intrauterine growth, weight, and gestational age at birth. RESULTS:We diagnosed 34 cases of peri-intraventricular hemorrhages (13 and 21, respectively), and both groups differed as to the birth weight and the adequacy of weight to the gestational age at birth. There was no difference in the prevalence or extent of peri-intraventricular hemorrhages among cases. There was a statistically significant occurrence of lower birth weight at gestational ages of less than 30 weeks.CONCLUSIONS: The prevalence of peri-intraventricular hemorrhages in our study was compared to that reported in the world literature. Although the cases of the second institution had a smaller mean birth weight, the prevalence of periintraventricular hemorrhages was similar to that at the first institution, probably because in the first one, 69% of the gestational ages of the neonates with hemorrhage were less than 30 weeks as compared to 48% in the second one. We stress the importance of the ultrasonographic method for diagnosing peri-intraventricular hemorrhages in very low birth weight newborns.

Aspectos perinatais relacionados à hemorragia intracraniana em recém-nascidos de muito baixo peso no Sul do Brasil

“…Em estudo em que se empregou US transfontanela para screening, os RNs com menos do que 32 semanas representaram quase metade da amostra, assim como nesse estudo em que a maioria da amostra teve menos que 30 semanas de gestação 8 . Outros estudos também registraram associação estatisticamente significativa entre idade gestacional menor do que 30 semanas e a ocorrência de HIC 19,20 . Apesar de não verificada diferença entre casos e controles, 71 (62,8%) RNs avaliados neste estudo apresentavam idade gestacional ≤ 30 semanas.…”

Efeitos de técnicas de desobstrução brônquica na mecânica respiratória de neonatos prematuros em ventilação pulmonar mecânica

“…(19) Effects of time on PMV on the tracheobronchial secretion were proven by a study where through cytopathologic evaluation of the tracheal aspirate of 108 children under PMV, it was observed that in the first 4 days of PMV destroyed cells of the bronchial epithelium were found and a large amount of preserved and intact cells. However, in children ventilated for 4 and 10 days, some small clusters of preserved bronchial cells were seen, many deteriorated, also leukocytes, monocytes and macrophages, (18) showing occurrence of an intense inflammatory process associated to greater production of pulmonary secretion.…”

“…The artificial airway and PMV favor production and drying of secretion, causing airway obstruction and loss of the mucocilliary function. (3,17,18) Furthermore, children of the PMV≥5 group had been exposed for more days, to sedation (a therapy often used in neonates under PMV), that reduced the coughing reflex and elimination of secretion, leading to clinical conditions that course with pulmonary infection. (19) Effects of time on PMV on the tracheobronchial secretion were proven by a study where through cytopathologic evaluation of the tracheal aspirate of 108 children under PMV, it was observed that in the first 4 days of PMV destroyed cells of the bronchial epithelium were found and a large amount of preserved and intact cells.…”

“…When the airflow reaches this region, secretion is a barrier to passage of gas, which is overcome, and carried together with the expiratory flow towards more central airways. (1,7,18) Another resource used in this study was selective decubitus which is well known in airway clearance. In healthy individual action of gravity does not seem to contribute to increase of mucus transport, however, whenever this transport is hindered and/or in presence of greater secretion volume, influence of gravity on its transport is important.…”

“…In healthy individual action of gravity does not seem to contribute to increase of mucus transport, however, whenever this transport is hindered and/or in presence of greater secretion volume, influence of gravity on its transport is important. (18,19) As selective decubitus was associated to a flow-dependent technique, better ventilation due to not dependent positioning of the lung (7) submitted to these techniques caused a greater local ventilation and consequently, greater effectiveness of the technique. As previously mentioned, Trendelemburg position where the head is lower than the trunk is completely contraindicated in prematures as it favors peri-intraventricular hemorrhage.…”