Risk Factors for Neonatal Intraventricular Haemorrhage in Spontaneous Prematurity at 32 Weeks Gestation or Less

Abstract

In this study we aimed to establish which clinical and histopathological factors are associated with early-onset neonatal intraventricular haemorrhage (IVH) in non-iatrogenic preterm delivery before 32 weeks of gestation.We retrospectively reviewed all singleton pregnancies delivered before 32 weeks of gestation after spontaneous onset of preterm labour or preterm membrane rupture during the period January 1993 to June 1997. Clinical and histopathological data in cases with IVH diagnosed at neonatal cranial ultrasound within 72h of birth (n=17) were compared with those of neonates not experiencing this complication (non-IVH) (n=54). Histological lesions analysed were those of acute inflammation and those on a uteroplacental vascular basis. Statistical methods included the Wilcoxon rank sum test, Fisher's exact test, and logistic regression analysis. A P< 0.05 was considered significant.IVH and non-IVH groups were not significantly different in birthweight, gestational age at delivery, cord pH at birth, rates of 5-min Apgar score below 7, caesarean delivery, diagnosis of clinical chorioamnionitis or antenatal administration of steroids. Respiratory distress syndrome was more frequently diagnosed in the IVH than non-IVH group (64 per cent versus 33 per cent, P=0.02). Placental acute inflammatory or uteroplacental vascular lesions were present in 100 per cent of IVH neonates versus 22 per cent of non-IVH cases (P< 0.001). Logistic regression analysis demonstrated that only respiratory distress syndrome (P=0.04) and histological evidence of acute placental inflammation (P=0.02) were significantly and independently associated with IVH.Histopathological evidence of acute inflammatory placental lesions is the best predictor of occurrence of neonatal IVH.