Risk Factors for Severity of Intraventricular Hemorrhage in Very Low Birth Weight Infants and Neurodevelopmental Outcomes

Abstract

Purpose : The purpose of this study is to investigate the perinatal risk factors for severity of intraventricular hemorrhage (IVH) in very low birth weight infants (VLBWIs) and to study the following neurodevelopmental outcomes depending on the degree of IVH severity. Methods : The retrospective study included 145 VLBWIs who were admitted at Seoul St. Mary’s Hospital between May of 2009 and April of 2013. Prenatal, obstetric and postnatal risk factors for IVH were investigated. VLBWIs were divided into the group of IVH grade 1-2 and IVH grade 3-4. During this study period, 26 VLBWIs were died and 11 VLBWIs were lost to followed up, thereby 108 infants were included in the final analysis. They were regularly followed up and assessed for presence of major neurodevelopmental impairments including cognitive impairment, cerebral palsy, visual deficit, hearing deficit, and epilepsy. Among 108 infants, 23 (21.3%) patients had neurodevelopmental impairments. Results : The lower gestational age and birth weight were significant prenatal risk factors for severe IVH. Lower Apgar score at 1 and 5 min, hypotension/shock, higher levels of partial pressure of carbon dioxide, presence of patent ductus arteriosus, pneumothorax, thrombocytopenia, necrotizing enterocolitis, and bronchopul monary dysplasia were significant postnatal risk factors for severe IVH. After multiple logistic regression analysis, gestational age, birth weight, and hypotension/shock were independent risk factors for severe IVH. The incidence of major neurodevelopmental impairments were also significantly higher in VLBWIs who survived after severe IVH. Conclusion : In addition to preterm birth, minimizing hypotension/shock, the risk factor of severe IVH, is important to prevent major neurodevelopmental impairments in VLBWIs.