Abstract
BackgroundGlobally, 15 million neonates are born prematurely every year, over half in low income countries (LICs). Premature and low birth weight neonates have a higher risk of intraventricular haemorrhage (IVH). There are minimal data regarding IVH in sub-Saharan Africa. This study aimed to examine the incidence, severity and timing of and modifiable risk factors for IVH amongst low-birth-weight neonates in Uganda.MethodsThis is a prospective cohort study of neonates with birthweights of ≤2000 g admitted to a neonatal unit (NU) in a regional referral hospital in eastern Uganda. Maternal data were collected from interviews and medical records. Neonates had cranial ultrasound (cUS) scans on the day of recruitment and days 3, 7 and 28 after birth. Risk factors were tabulated and are presented alongside odds ratios (ORs) and adjusted odds ratios (aORs) for IVH incidence. Outcomes included incidence, timing and severity of IVH and 28-day survival.ResultsOverall, 120 neonates were recruited. IVH was reported in 34.2% of neonates; 19.2% had low grade (Papile grades 1–2) and 15% had high grade (Papile grades 3–4). Almost all IVH (90.2%) occurred by day 7, including 88.9% of high grade IVH. Of those with known outcomes, 70.4% (81/115) were alive on day 28 and survival was not associated with IVH. We found that vaginal delivery, gestational age (GA) < 32 weeks and resuscitation in the NU increased the odds of IVH. Of the 6 neonates who received 2 doses of antenatal steroids, none had IVH.ConclusionIn this resource limited NU in eastern Uganda, more than a third of neonates born weighing ≤2000 g had an IVH and the majority of these occurred by day 7. We found that vaginal birth, earlier gestation and need for resuscitation after admission to the NU increased the risk of IVH. This study had a high rate of SGA neonates and the risk factors and relationship of these factors with IVH in this setting needs further investigation. The role of antenatal steroids in the prevention of IVH in LICs also needs urgent exploration.
Highlights
15 million neonates are born prematurely every year, with more than half being in low-income countries (LICs) [1, 2]
The Ugandan National Guidelines recommend antenatal steroids are given to all women in threatened preterm or preterm labour and intrapartum antibiotics are given to women with signs of sepsis, chorioamnionitis or preterm premature rupture of membranes (PPROM) but the practice is not ubiquitous [23]
During the 5-month study period, 839 neonates were admitted to Mbale Regional Referral Hospital (MRRH)-neonatal unit (NU), 240 (28.6%) of whom weighed ≤2000 g and were screened for enrolment eligibility
Summary
15 million neonates are born prematurely every year, with more than half being in low-income countries (LICs) [1, 2]. Preterm and low birth weight (LBW) neonates are at increased risk of intracranial bleeding, intraventricular haemorrhage (IVH), with those < 32 weeks gestational age (GA) or < 1500 g at highest risk [4, 5]. In high income countries (HICs), IVH has been shown to contribute significantly to both mortality and cognitive and motor neurological impairment in premature and LBW neonates [4, 6,7,8]. Data regarding the incidence, risk factors and complications of IVH in LICs are scarce [9,10,11,12]. Premature and low birth weight neonates have a higher risk of intraventricular haemorrhage (IVH). This study aimed to examine the incidence, severity and timing of and modifiable risk factors for IVH amongst low-birth-weight neonates in Uganda
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