Temporal trends of intraventricular hemorrhage of prematurity in Nova Scotia from 1993 to 2012

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Intraventicular hemorrhage (IVH) and posthemorrhagic hydrocephalus (PHH) are common in premature newborns. The epidemiology of these conditions has been described, but selection bias remains a significant concern in many studies. The goal of this study was to review temporal trends in the incidence of IVH, PHH, and shunt surgery in a population-based cohort of very preterm infants with no selection bias.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>All very preterm infants (gestational age ≥ 20 and ≤ 30 weeks) born from 1993 onward to residents of Nova Scotia were evaluated by the IWK Health Centre's Perinatal Follow-Up Program, and were entered in a database. Infants born to residents of Nova Scotia from January 1, 1993, to December 31, 2012, were included in this study. The incidences of IVH, PHH, and shunt surgery were calculated, basic demographic information was described, and chi-square test for trends over time was determined.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Of 1334 successfully resuscitated very preterm infants who survived to their initial screening ultrasound, 407 (31%) had an IVH, and 149 (11%) had an IVH Grade 3 or 4. No patients with IVH Grade 1 or 2 developed PHH. The percentage of very preterm infants with IVH Grade 3 or 4 has significantly increased over time (p = 0.013), as have the incidence of PHH and shunt surgery (p = 0.001 and p = 0.011, respectively) in infants with Grade 3 or 4 IVH. The proportion of patients with PHH receiving a shunt has not changed over time (p = 0.813).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The increasing incidence of high-grade IVH—and PHH and shunt surgery in infants with high-grade IVH—over time is worrisome. This study identifies a number of associated factors, but further research to identify preventable and treatable causal factors is warranted.</jats:p></jats:sec>

Effects of Delayed Cord Clamping on Intraventricular Hemorrhage in Preterm Infants

“…The outcome was significantly different between the two groups. In a study by Chiruvolu et al (2015) to examine the effect of delayed cord clamping on the incidence of IVH in preterm infants with gestational age less than 32 weeks, the rate of morbidity or mortality was not (10,13). The above results are in line with the results of this study and suggest that this method is safe and without complications.…”

Restricted Ventilation Associated with Reduced Neurodevelopmental Impairment in Preterm Infants

“…Next, we performed a multiple logistic regression analysis correcting for these confounders present at birth. In a second analysis, we also added the intermediate NEC occurring during hospitalization for the outcome BPD, and NEC and IVH for the long-term neurodevelopmental outcomes [18,19]. Differences in respiratory variables and outcomes that might have an impact on mortality, BPD, or NDI were not entered as intermediates in the multiple regression analysis because these were considered part of the noninvasive respiratory support policy.…”

Predictors of mortality for preterm infants with intraventricular hemorrhage: a population-based study

“…Most studies on IVH outcomes have relied on single-institution data, collaborative networks, or patient registries, but there is a dearth of longitudinal, population-level data regarding IVH [8, 17, 23, 25, 34, 43]. Few studies have investigated the long-term neurosurgical outcomes of infants affected with IVH, such as shunt complications [2, 9, 10, 21, 29, 30, 39, 40]. Several studies have made use of the Nationwide Inpatient Sample (NIS) and Kids’ Inpatient Database (KID) which, while providing a representative sample of national inpatient discharges, have the important limitation of only capturing a single admission and therefore cannot follow outcomes longitudinally across subsequent hospitalizations [3, 7, 18, 28, 36].…”