Risk factors for periventricular-intraventricular haemorrhage severity in preterm infants: A propensity score-matched analysis

Abstract

Background: Most previous studies comparing etiological studies in infants with and without periventricular-intraventricular haemorrhage (PV-IVH) concluded that younger gestational age (GA) was associated with a higher prevalence rate of PV-IVH. However, only few studies have examined the risk factors associated with the severity of PV-IVH after removing the influence of GA. Therefore, we investigated the risk factors apart from GA for PV-IVH severity in preterm infants less than 32 weeks. Methods: This was a retrospective case-control study of preterm infants born in West China Second Hospital with PV-IVH between 2009 and 2018. PV-IVH was defined using cranial ultrasound screening. Preterm infants with PV-IVH were divided into mild and severe groups. Both groups were matched in a 1:1 ratio using propensity score calculated from GA. Variables were collected from infant–mother pairs. A stepwise forward multivariate logistic regression model was adopted to select factors that affected the severity of PV-IVH in preterm infants. Results: A total of 3,783 preterm infants with PV-IVH were included. The total incidence of PV-IVH in preterm infants was 15.58%, and the incidence of PV-IVH of grades I, II, III, and IV was 2.50%, 9.52%, 3.13%, and 0.42%, respectively. The mortality of mild and severe PV-IVH was 0.33% and 3.25%, respectively. We matched 315 infants with severe PV-IVH with 315 infants with mild PV-IVH. The results suggested that early-onset sepsis (odds ratio [OR] 2.50, 95% confidence interval [CI]: 1.50–4.16), thrombocytopenia (OR 2.37, 95% CI: 1.39–4.04), multiple gestations (OR 1.69, 95% CI: 1.15–2.49), invasive mechanical ventilation (OR 1.59, 95% CI: 1.10–2.31), and magnesium sulphate use (OR 1.46, 95% CI: 1.01–2.10) were associated with severe PV-IVH. Female sex (OR 0.65, 95% CI: 0.46–0.91) was a protective factor against severe PV-IVH. Conclusions: Early-onset sepsis, thrombocytopenia, multiple gestations, invasive mechanical ventilation, magnesium sulphate use, and male sex contributed to severe PV-IVH in preterm infants regardless of GA, these risk factors may combine to predict the incidence of PV-IVH in preterm infants.