INTRAVENTRICULAR HEMORRHAGES IN NEONATOLOGY: PREDICTION OF THE LETHAL CASES IN PREMATURE INFANTS

Abstract

Introduction. Severe intraventricular hemorrhages (IVH) in children born prematurely remain a significant problem of neonatal hospitals and intensive care units throughout the world. The incidence of GIII - IV degree in children with gestational age less than 32 weeks is 25%, the mortality rate among prematurely born children with IVH IV Art. - up to 60%. Previous studies indicate stable mortality rates in a cohort of newborns with severe IVH in the Poltava region during 2009–2017, they remain quite high in both children born with a weight <1000 and among children weighing 1000–1499. ., and significantly higher than in the developed countries of the world. Despite many different clinical studies on the problem of intraventricular hemorrhage, the causes of development, risk factors, as well as prediction of fatal cases in children born prematurely with existing severe IVH remain unclear and debatable.The aim of this work: was to determine the reliable risk factors for the occurrence of lethal cases among premature infants with IVHs and to develop a predictive model of lethal events in premature infants with severe IVH.Materials and methods. A multicentre study was conducted, which included children with III and IV grade of IVHs by Papile classification, the grade of IVHswasestablished during sonography up to 3 days of life. The study group consisted of 76 premature infants: 40 infants (body weight at birth 903,72 ± 56,61 g, GA 26,15 ± 0,34 weeks) who died, and 36 infants (body weight 1187,3 ± 58,0 g, GA 28.09 ± 0,37 weeks) who survived. The definition of risk factors, which are reliably associated with the development of lethal cases in newborns with IVHs, has been carried out. The simple logistic regression analysis was carried out to identify factors that are reliably associated with the development of IVHs in premature infants,these obtained data became a sound tool for inventing a predictive model using multiple logistic analysis and further evaluation of operational characteristics using the STATA 11.0 application package.Research results. Premature infants with IVHs, whosedisease courses ended in lethal cases, had significantly less gestational age (p = 0,001) and body weight at birth (p = 0,003) than prematuresurvivors. Due to the simple regression analysis, there were found associations between the occurrence of the lethal case and GA (OR = 0,66; p = 0,01); tracheal intubation (OR 0.4; p = 0,055); introduction of surfactant in the delivery room (OR = 0.16; p = 0,025); sepsis (OR 3,2; p = 0,027), severe RDS (OR 8,1; p = 0,001), infection (level of CRP) (OR 2.45; p = 0,072), number of WBC (OR1,1; p = 0,01) and platelets (OR 0,99; p = 0,007) on the 6th day of life.The prognostic model of the development of lethal cases was developed, which included the following variables: intubation during resuscitation, severe RDS, number of WBC (x109 / l) and platelets (x109 / l) on the6th day of life, sensitivity - 71,4 %, specificity – 100,0 %, positive predictive value is 100 %, negative predictive value is 76 % and area under the ROC curve is 0,9373.Conclusions. The prognostic model for the development of lethal events in newborns with IVHs, which includes: intubation during resuscitation (β = -4,16), presence of severe RDS (β = 4,4), platelets count (β = -0,02 ) and the level of WBC (β = 0,11) on the 6thday after birth has high operational characteristics.Conclusions. Prognostic model of development of deaths in newborns with IVH, which includes: intubation during resuscitation (β=-4.16), the presence of severe RDS (β=4.4), platelet count (β=-0.02) and the level of leukocytes (β=0.11) on day 6 after birth has high operational characteristics and may be recommended the use of this model in in neonatology practical.