Risk factors for the deterioration of periventricular–intraventricular hemorrhage in preterm infants

Abstract

Preterm infants with periventricular-intraventricular hemorrhage (PV-IVH) have a high risk of neurological sequelae, with severity depending on the severity of the PV-IVH. Previous studies on the pathogenesis of PV-IVH have focused mainly on comparisons of perinatal risk factors between patients with and without PV-IVH. Notably, most cases of PV-IVH occur within the first 3 days after birth, and the condition may worsen within 1 week following the initial diagnosis. However, the risk factors that contribute to the deterioration of PV-IVH have not been investigated. In this cohort study, 514 PV-IVH infants with a gestational age (GA) < 32 weeks were enrolled. The dependent variable was initially diagnosed as mild PV-IVH (grade I or II) that subsequently progressed to severe PV-IVH (grade III or IV) within 1 week. A stepwise forward multivariate logistic regression model was adopted to select potential or related factors that affected the deterioration of PV-IVH in preterm infants. Overall, 42 of the 514 infants with PV-IVH (8.2%) showed deterioration within 1 week. The results showed that maternal lower genital tract infection (OR 3.73, 95% CI 1.75-7.95) was an independent risk factor for PV-IVH deterioration. Higher GA (OR 0.62, 95% CI 0.48-0.80) was a protective factor. Our results suggest that maternal lower genital tract infection and a lower GA may contribute to PV-IVH deterioration in preterm infants. Periventricular-intraventricular hemorrhage (PV-IVH) is a common intracranial lesion in premature infants and is characterized as bleeding into the ventricular system due to the rupture of microvessels within the germinal matrix tissue 1. The incidence of PV-IVH is higher in neonates with a younger gestational age (GA) than in other groups and is especially high in neonates with GA < 32 weeks 2. PV-IVH ranges in severity from grade I to grade IV according to the Papile grading system 3. In the majority of infants with mild PV-IVH (grade I and II), the clinical prognosis is generally favorable 4. However, up to approximately 60% of infants with severe PV-IVH (grades III and IV) develop cerebral palsy and/or mental retardation 5. These severe sequelae create enormous social and financial burdens. To date, no treatment has been able to reduce the sequelae of IVH in preterm infants 6. Notably, PV-IVH mainly occurs within the first 3 days after birth and can progress rapidly early in life (within 1 week) 5,7. Therefore, it is very important to detect risk factors for PV-IVH deterioration as this could help pediatricians prevent deterioration from mild to severe PV-IVH. Previous studies have evaluated the risk factors for PV-IVH in preterm infants by comparing PV-IVH infants to those without PV-IVH, and these studies have identified vaginal delivery, intrauterine infection, asphyxia, postpartum mechanical ventilation, coagulopathy, thrombocytopenia, etc. as perinatal risk factors 8,9. Whether these risk factors contribute to PV-IVH deterioration remains unknown. Therefore, the present study was performed to explore t...

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

“…This study adopted the Papile's grading system [18,19] where Grade I represented subependymal haemorrhage, Grade II -intraventricular haemorrhage without dilation, Grade III -intraventricular haemorrhage with ventricular dilation and Grade IV -intraventricular haemorrhage with parenchymal haemorrhage; the most prevalent grade was Grade I at 51.4% with equal proportions for Grades II, III and IV at 16.2% each. This grade I finding, although lower than that reported in a study conducted in China [4] at 63.2%, shows a similar trend in the highest proportion by IVH grade. However, there were contrasting findings in Grade II and III/IV at 12.3% and 24.1% respectively, a difference that could be attributed to the retrospective design of the study compared to the current study which adopted a prospective study design.…”

“…This condition is multifactorial in nature and is often reported in cases of fibronectin deficiency in the germinal matrix basal lamina [3]. Intraventricular haemorrhage pathogenesis is associated with irregularities in cerebral blood flow, coagulation and platelet abnormalities that worsen the bleeding making this very critical infant in the integrity of the germinal matrix [4,5]. Some of the etiological risk factors for IVH include very low birthweight (<1500 grammes), very low to extremely low gestational age (< 32 weeks), absence of prenatal corticosteroid use for women at risk of premature mature delivery [2] and early clamping of the umbilical cord [6].…”

Predictive Risk Factors for Mild and Severe Germinal Matrix Hemorrhage and Associated Neurodevelopmental Prognosis: A Retrospective Study

“…Antenatal infection, including lower genital tract infection during pregnancy, is associated with a higher risk of having severe GMH-IVH as resulted in our study. In other studies, they found that antenatal infection and maternal lower genital tract infection are risk factors for developing and early deterioration of GMH-IVH [10,5]. The study mentioned that infections and inflammatory responses are strongly associated with neonatal brain injury, including GMH-IVH.…”

“…Early management of lower genital tract infection is essential in preventing GMH-IVH in neonates [5].…”

“…Several published studies have discussed and analysed sets of factors that potentially increase the risk of developing GMH-IVH in preterm infants. These factors include maternal factors, such as lower gestational age (GA), infection of the lower genital tract, and antenatal infections as well as neonatal factors, such as low birth weight, presence of patent ductus arteriosus (PDA), being male, white race, low APGAR score, and respiratory distress syndrome (RDS) [4,5,6,7]. However, there is no obvious association between the risk factors and the severity of GMH-IVH and whether the presence of some risk factors can predict later neurological complications.…”