Abstract
To identify the frequency of intracranial hemorrhage and its associated factors in premature newborns. A cross-sectional study based on a survey of medical records of premature neonates submitted to transfontanellar ultrasound at a hospital located in a southern neighborhood of the city of São Paulo, in 2007. A 50% rate of intracranial hemorrhage was found among premature newborns submitted to transfontanellar ultrasound, and 15.35% among all premature babies born in this hospital in 2007. The statistically significant factors associated to intracranial hemorrhage were gestational age less than 32 weeks, absence of prenatal care, invasive mechanical ventilation, infection, blood transfusion, hyaline membrane disease, hyponatremia and hyperglycemia. The frequency of peri-intraventricular hemorrhage was 50% in patients at risk and 15.35% among all premature babies; the associated factors were gestational age less than 32 weeks, absence of prenatal care, need of invasive mechanical ventilation, infection, blood transfusion, hyaline membrane disease, hyponatremia and hyperglycemia.
Highlights
Peri-intraventricular hemorrhage (PIVH) represents a huge problem in premature neonates due to its frequency, severity and prognosis.Some studies demonstrated a frequency of 13 to 29.8% in newborns younger than 32 weeks of gestational age (GA) and of up to 44.68% among all premature babies[1,2,3,4,5,6].PIVH occurs more often in premature neonates for having the subependymal germinal matrix, an immature tissue consisted by germinative cells, located in the subependymal region of the lateral ventricle anterior horns
41.9% were males; 58.1% with birth weight between 1,501 and 2,500 g; 27.0% with birth weight between 1,001 and 1,500 g; and 10.8% weighed less than 1,000 g; 32.4% with GA less than 32 weeks; 85.1% less than 35 weeks; 27.0% with no prenatal care; 12.2% died during hospital stay; 31.1% were SGA; 60.8% were born by vaginal delivery; 66.2% were in invasive mechanical ventilation and 9.5% received prenatal steroids
Concerning GA, 87.5% of the neonates younger than 32 weeks in this study presented PIVH, and the difference is statistically significant (p < 0.0005) in relation to premature neonates with GA between 32 and 37 weeks
Summary
Peri-intraventricular hemorrhage (PIVH) represents a huge problem in premature neonates due to its frequency, severity and prognosis. PIVH occurs more often in premature neonates for having the subependymal germinal matrix, an immature tissue consisted by germinative cells, located in the subependymal region of the lateral ventricle anterior horns. This tissue is highly vascularized, and the vessels have thin walls and are subject to damage as a consequence to variations in brain blood flow. The subependymal germinal matrix is not found in neonates born at term, 316 Guzman EA, Bertagnon JRD, Juliano Y since its germinative cells migrate to more superficial regions of the brain as the fetus matures[1,2,7,8,9]
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