Prevalence of intraventricular haemorrhage and determinants of its early outcomes among preterm neonates at the newborn unit of a teaching hospital in Western Kenya

Abstract

Intraventricular haemorrhage (IVH) screened using cranial ultrasounds (cUS) is a major cause of morbidity and mortality among preterm neonates. Despite the adverse neonatal outcomes attributed to IVH, there are limited studies conducted in sub-Saharan Africa on IVH occurrence and determinants of early outcomes. This study assessed the proportion of neonates with IVH, its determinants and the early outcomes of preterm neonates with the condition. A prospective descriptive study conducted at the newborn unit of Moi Teaching and Referral Hospital in Western Kenya between March 2020 to March 2021. The neonates sampled systematically had their clinical characteristics and that of their mothers collected from medical records. A cUS screening was conducted on the third and fourteenth day of life while hydrocephalus was screened using serial weekly measurements of head circumference and mortality assessed within the first 28 days of life. Bivariate analysis was used to test for an association between patient characteristics, occurrence of IVH and early outcomes. Confounders were controlled using a multivariate logistic regression model. We enrolled 201 pre-term neonates of whom 105 (52.2%) were male and 68 (33.8%) had IVH. Among neonates with IVH, 46 (67.6%) had mild while 22 (32.4%) had severe IVH. Antenatal steroids significantly reduced the risk of IVH while extreme/very low gestational age and extremely low birthweight significantly increased the risk of IVH two and three-fold respectively. Neonates with thrombocytopenia and on mechanical ventilation were significantly more likely to be diagnosed with IVH. Early outcomes of IVH were hydrocephalus (4.0%) and mortality (19.1%). Intraventricular hemorrhage was seen in one-third of neonates enrolled with majority of them presenting with the lower IVH grades. The IVH risk significantly increased among neonates with very low gestational age and extremely low birthweight but was lowered by antenatal steroid use. Mortality rates were significantly higher among neonates with thrombocytopenia.