Incidence and risk factors of severe intraventricular hemorrhage in very low and extremely low birth weight infants: a multi-center study

Abstract

Objective: To investigate the incidence and risk factors of severe intraventricular hemorrhage (IVH) in very low birth weight infants (VLBWI) and extremely low birth weight infants (ELBWI). Methods: The data were from "reduction of infection in Chinese neonatal intensive care units using the evidence-based practice for improving quality"study, which prospectively enrolled infants with gestational age less than 34 weeks, and were admitted within the first seven days of life in 25 tertiary neonatal intensive care units from May 2015 to April 2018. Clinical data of VLBWI and ELBWI, who had neuroimage examination during the hospitalization, were retrospectively extracted from the standard database and were secondarily-analyzed. Patients with congenital malformations were excluded. A total of 8 835 VLBWI and ELBWI were enrolled with 52.6% (4 643 cases) male, who were divided into severe IVH group and without IVH or mild IVH group. Descriptive statistics were used to analyze the incidence of severe IVH. Comparison between two groups and risk factors were analyzed with univariate and multivariate Logistic regression analysis. Results: The incidence of severe IVH in the 8 835 infants was 7.4% (650/8 835). And the incidences of severe IVH in ELBWI and preterm infants with gestational age ≤28 weeks were 13.5% (160/1 185) and 13.1% (368/2 800), respectively. The incidences of severe IVH in preterm infants with birth weight<750 g, 750-999 g, 1 000-1 249 g, 1 250-1 499 g were 21.1% (31/147), 12.4% (129/1 038), 8.3% (246/2 966) and 5.2% (244/4 684), respectively; and were 25.2% (55/218), 12.1% (313/2 582), 5.2% (243/4 649) and 2.8% (39/1 386) in the preterm infants with gestational age<26 weeks, 26-28(+6) weeks, 29-31(+6) weeks, 32-33(+6) weeks, respectively. Logistic regression analysis revealed that gestation age (OR=0.752, 95%CI: 0.687-0.823, P=0.000) and cesarean delivery (OR=0.733, 95%CI: 0.592-0.907, P=0.004) decreased the risks of severe IVH; while Apgar score ≤3 at 5 minutes (OR=1.897, 95%CI: 1.194-3.013, P=0.007), use of invasive mechanical ventilation within the first week (OR=1.499, 95%CI: 1.207-1.862, P=0.000), use of inotropic medications within the first week (OR=2.093, 95%CI: 1.724-2.541, P=0.000) increased the risks of severe IVH. Conclusions: The incidence of severe IVH is still significantly high among VLBWI and ELBWI. Low gestation age, non-cesarean delivery, Apgar score ≤3 at 5 minutes, use of invasive mechanical ventilation and inotropic medications within the first week of life will increase the risk of severe IVH.