Abstract
BackgroundIntraventricular hemorrhage (IVH) is uncommon in term newborns. Asphyxia and hypothermia have been mentioned separately as possible risk factors of IVH, since they might cause fluctuations of cerebral blood flow. The aim of this study was to assess the incidence, the timing, and the risk factors of intraventricular hemorrhage (IVH) in term asphyxiated newborns treated with hypothermia.MethodsWe conducted a prospective cohort study of all term asphyxiated newborns treated with hypothermia from August 2008 to June 2013. The presence or not of IVH was assessed using brain magnetic resonance imaging (MRI) performed after the hypothermia treatment was completed or using head ultrasound during the hypothermia treatment. For these newborns, to determine the timing of IVH, we retrospectively reviewed if they had other brain imaging studies performed during their neonatal hospitalization stay. In addition, we compared their general characteristics with those not developing IVH.ResultsOne hundred and sixty asphyxiated newborns met the criteria for hypothermia. Fifteen of these newborns developed IVH, leading to an estimate of 9 % (95 % CI: 5.3-15.0 %) of IVH in this population of newborns. Fifty-three percent had hemorrhage limited to the choroid plexus or IVH without ventricular dilatation; 47 % had IVH with ventricular dilatation or parenchymal hemorrhage. Sixty-seven percent had an initial normal brain imaging; the diagnostic brain imaging that demonstrated the IVH was obtained either during cooling (in 30 %), within 24 h of the rewarming (in 30 %), or 24 h after the rewarming (in 40 %). Recurrent seizures were the presenting symptom of IVH during the rewarming in 20 % of the newborns. Coagulopathy was more frequent in the asphyxiated newborns developing IVH (p < 0.001). The asphyxiated newborns developing IVH also presented more frequently with persistent pulmonary hypertension, hypotension, thrombocytopenia and coagulopathy (p = 0.03).ConclusionsThe asphyxiated newborns treated with hypothermia appear to be at an increased risk of IVH, especially those with significant hemodynamic instability. IVH seems to develop during late hypothermia and rewarming. Efforts should be directed towards maintaining hemodynamic stability in these patients, even during the rewarming.
Highlights
Intraventricular hemorrhage (IVH) is uncommon in term newborns
As per the current standard protocol in our neonatal intensive care unit to evaluate for brain injury in these newborns, only a brain magnetic resonance imaging (MRI) was performed after the hypothermia treatment was completed, except for the very sick newborns who may die from the complications of neonatal encephalopathy for whom a head ultrasound was requested at the bedside during hypothermia treatment
Intraventricular hemorrhage was categorized as either a hemorrhage limited to the choroid plexus in the lateral ventricle, an IVH without ventricular dilatation, an IVH with ventricular dilatation, or a parenchymal hemorrhage
Summary
Intraventricular hemorrhage (IVH) is uncommon in term newborns. The aim of this study was to assess the incidence, the timing, and the risk factors of intraventricular hemorrhage (IVH) in term asphyxiated newborns treated with hypothermia. Intraventricular hemorrhage is uncommon in term newborns [1,2,3]. The IVH that develops in the context of neonatal encephalopathy may cause an additional barrier for the optimal development of these newborns. Studies are needed to understand whether asphyxiated newborns treated with hypothermia are at a greater risk of developing IVH, when they are the most at risk for it (i.e., during hypothermia, during rewarming, or after the completion of treatment), and what are the risk factors for developing IVH. Intracranial hemorrhages included 85 % of subdural hematomas, and the exact frequency of IVH was not described [11]
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