Reduction of severe intraventricular hemorrhage, a tertiary single-center experience: incidence trends, associated risk factors, and hospital policy

Wafa Sattam M Alotaibi,Omar S Aldibasi,Nada S Alsaif,Aly Farouk Mahmoud,Ibrahim A Ahmed,Abdullah Hammad,Kamal Ali,Saif A Alsaif

doi:10.1007/s00381-020-04621-7

Abstract

ObjectivesTo determine the incidence, trends, maternal and neonatal risk factors of severe intraventricular hemorrhage (IVH) among infants born 24–32 weeks and/or < 1500 g, and to evaluate the impact of changing of hospital policies and unit clinical practice on the IVH incidence.Study designRetrospective chart review of preterm infants with a gestational age (GA) of 24–326 weeks and/or weight of < 1500 g born at King Abdulaziz Medical City–Riyadh (KAMC-R), Saudi Arabia, from 2016 to 2018. Multivariate logistic regression model was constructed to determine the probability of developing severe IVH and identify associations with maternal and neonatal risk factors.ResultsAmong 640 infants, the overall incidence of severe IVH was 6.4% (41 infants), and its rate decreased significantly, from 9.4% in 2016 to 4.5% and 5% in 2017 and 2018 (p = 0.044). Multivariate analysis revealed that caesarian section delivery decreased the risk of severe IVH in GA group 24–27 weeks (p = 0.045). Furthermore use of inotropes (p = 0.0004) and surfactant (p = 0.0003) increased the risk of severe IVH. Despite increasing use of inotropes (p = 0.024), surfactant therapy (p = 0.034), and need for delivery room intubation (p = 0.015), there was a significant reduction in the incidence of severe IVH following the change in unit clinical practice and hospital policy (p = 0.007).ConclusionCesarean section was associated with decreased all grades of IVH and severe IVH, while use of inotropes was associated with increased severe IVH. The changes in hospital and unit policy were correlated with decreased IVH during the study period.

Highlights

Neurological sequelae are found in approximately 50–75% of preterm survivors with severe intraventricular hemorrhage (IVH); it remains a significant public health concern worldwide [1].According to the National Institute of Child Health and Human Development (NICHD) Neonatal Research Network, in 2016, 23.7% of sonograms of extremely low gestational age (GA) and VLBW infants indicated the development of IVH, where 31.6% of these cases were classified as severe IVH [2]
Recent data from the Korean Neonatal Network showed that the overall incidence of IVH in VLBW infants was 42.5%, while severe IVH was 10.3% [3], and few studies in the Middle East have reported that severe IVH occurs in 8.1% and as high as 11% among highrisk infants [4, 5]
717 infants with GA of 24–32 [2] weeks and/or birth weight of < 1500 g were admitted to our neonatal intensive care unit (NICU)

Summary

Introduction

According to the National Institute of Child Health and Human Development (NICHD) Neonatal Research Network, in 2016, 23.7% of sonograms of extremely low gestational age (GA) and VLBW infants indicated the development of IVH, where 31.6% of these cases were classified as severe IVH [2]. Recent data from the Korean Neonatal Network showed that the overall incidence of IVH in VLBW infants was 42.5%, while severe IVH was 10.3% [3], and few studies in the Middle East have reported that severe IVH occurs in 8.1% and as high as 11% among highrisk infants [4, 5]. Some studies examine the associated risk factors of IVH in preterm infants. Other risk factors include hypotension and hypercapnia as they cause significant fluctuations in cerebral blood flow [7]

Objectives

Methods

Results

Conclusion