Intraventricular Hemorrhage In Preterm Infants Research Articles

Effects of Delayed Cord Clamping on Intraventricular Hemorrhage in Preterm Infants

Background: One of the benefits of delayed cord clamping is a reduction in the rate of intraventricular hemorrhage. The findings in this regard are controversial and some negative effects of the procedure have been reported. Objectives: The purpose of this study was to investigate the effects of delayed cord clamping on intraventricular hemorrhage in preterm infants. Methods: This clinical trial was carried out on 70 preterm neonates delivered via cesarean section. Their gestational age was less than 32 weeks and the birth weight less than 1500 grams. Neonates were randomly assigned to two groups of early cord clamping (less than 10 seconds) or delayed clamping of the umbilical cord (30 - 45 seconds after birth). 3 to 7 days after birth, presence of Intraventricular hemorrhage (IVH) in both groups was checked by ultrasonography (Mindray machine, model m7) and. Rate and severity of IVH was compared between the two groups. Results: There was no significant difference in mean gestational age, birth weight, gender distribution and medications in both groups of delayed cord clamping and early clamping of the umbilical cord. The incidence of seizures in the early clamping was 8.6% and in the delayed clamping zero (P = 0.239). The incidence rate of IVH and periventricular leukomalacia (PVL) was 11.43% and 5.7%, respectively in the early clamping, while this rate was zero in the delayed clamping group. This difference was not statistically significant in both indicators (P = 0.12 and P = 0.493, respectively). Conclusions: The results showed that intraventricular hemorrhage in premature neonates with delayed clamping was less prevalent than those with early clamping, and may be used as a reliable method.

The Survey of Magnesium Sulfate in Prevention of Intraventricular Hemorrhage in Premature Infants: A Randomized Clinical Trial

Background: Intraventricular hemorrhage (IVH) is a common complication seen in premature infants. Since the brain intraventricular hemorrhage in any degree of risk is an important factor in long-term neuropathology, the role of magnesium sulfate on cerebral hemorrhage requires further investigation. Therefore, this study aimed to investigate the effect of magnesium sulfate on intraventricular hemorrhage in infants of mothers with premature rupture of membranes. Methods: This study is a double blind clinical trial (IRCT: IRCT2016080729223N1) on 120 pregnant women with premature rupture of membranes at 34 weeks admitted to the hospital of Shahid Akbar Abadi that were selected based on the inclusion criteria and assigned to two groups (magnesium sulfate recipients and non-recipients). The significance level was set at p<0.05. Results: The mean age was 28.17 ± 6.21 in the intervention group and 28.33 ± 5.97 in the control group that showed no statistically significant difference between the groups. The average weight of infants in the intervention group and in the control group was 2336.1 ± 526.8 and 1975.3 ± 233.4, respectively, which showed no significant difference. No intraventricular brain hemorrhage occurred in the infants of the two groups. Conclusions: Magnesium sulfate needs more evaluation in prevention of intraventricular hemorrhage in infants of mothers with premature rupture of membranes at 34 weeks.

Perfusion monitoring and intraventricular hemorrhage in preterm infants.

Cardiovascular instability in preterm infants during the early postnatal period correlates with the development of intraventricular hemorrhage (IVH). Due to the correlation between hypotension and fluctuation of blood pressure, treatment was targeted specifically at hypotension to prevent IVH, but this was not successful. Recently, several novel perfusion markers have been found to be correlated with the development of IVH, and they are of current interest in cardiovascular management. In this review, the correlation between IVH and conventional, as well as novel, perfusion markers is examined.

Pharmacological pain and sedation interventions for the prevention of intraventricular hemorrhage in preterm infants on assisted ventilation - an overview of systematic reviews

This is a protocol for a Cochrane Review (Overview). The objectives are as follows: To summarize the evidence from systematic reviews regarding the effects and safety of pharmacological interventions related to pain and sedation management in order to prevent GMH-IVH in ventilated preterm infants.

Randomized controlled trial of antenatal magnesium sulfate for short-term neuroprotection in premature neonates

Objective: To test the hypothesis that antenatal magnesium sulfate (MgSO4) has a short term neuroprotective role in the early neonatal period, when given to women considered at risk for preterm delivery in a developing country. Study Design: Randomized, placebo-controlled, open label, trial. Participants: A total of 126 mothers who delivered at or below 34 weeks gestation were randomized to receive either antenatal MgSO4 (cases) or normal saline as placebo (controls). A total of 108 babies born were observed for the primary and secondary outcomes. Primary Outcome: The composite of the incidence of death and intraventricular hemorrhage (IVH) by cranial ultrasonography in surviving preterm infants. Results: There were 6 deaths in cases and 11 deaths in controls (relative risk [RR]: 0.54; 95% confidence interval [CI]: 0.2173-1.369; p=0.18). A statistically significant reduction in the number of IVH was observed in cases (n=1) compared to controls (n=9) (RR: 0.11; 95% CI: 0.0145-0.897; p=0.016) with a number needed to treat of 7. Conclusion: Antenatal MgSO4 resulted in a significant reduction in the risk of IVH in preterm infants born at or below 34 weeks of gestation.

High grade intraventricular hemorrhage in preterm infant – Risk factors and outcome

High grade intraventricular hemorrhage in preterm infant – Risk factors and outcome

Prediction of intraventricular haemorrhage in preterm infants using time series analysis of blood pressure and respiratory signals

Despite the decline in mortality rates of extremely preterm infants, intraventricular haemorrhage (IVH) remains common in survivors. The need for resuscitation and cardiorespiratory management, particularly within the first 24 hours of life, are important factors in the incidence and timing of IVH. Variability analyses of heart rate and blood pressure data has demonstrated potential approaches to predictive monitoring. In this study, we investigated the early identification of infants at a high risk of developing IVH, using time series analysis of blood pressure and respiratory data. We also explore approaches to improving model performance, such as the inclusion of multiple variables and signal pre-processing to enhance the results from detrended fluctuation analysis. Of the models we evaluated, the highest area under receiver-operator characteristic curve (5th, 95th percentile) achieved was 0.921 (0.82, 1.00) by mean diastolic blood pressure and the long-term scaling exponent of pulse interval (PI α2), exhibiting a sensitivity of >90% at a specificity of 75%. Following evaluation in a larger population, our approach may be useful in predictive monitoring to identify infants at high risk of developing IVH, offering caregivers more time to adjust intensive care treatment.

Role of endothelial nitric oxide synthase and endothelin-1 polymorphism genes with the pathogenesis of intraventricular hemorrhage in preterm infants

In the pathogenesis of neonatal intraventricular hemorrhage (IVH) in preterm infants, an important role is played by changes in venous and arterial cerebral flows. It has been shown that the ability of autoregulation of cerebral flows in response to variations in arterial blood pressure in preterm infants is impaired. This impaired autoregulation causes an increased risk of germinal matrix rupture and IVH occurrence. We examined three polymorphisms of genes, related to regulation of blood flow, for an association with IVH in 100 preterm infants born from singleton pregnancy, before 32 + 0 weeks of gestation, exposed to antenatal steroids therapy, and without congenital abnormalities. These polymorphisms include: eNOS (894G > T and −786T > C) and EDN1 (5665G > T ) gene. We found that infants with genotype GT eNOS 894G > T have 3.4-fold higher risk developing of IVH born before 28 + 6 weeks of gestation. Our investigation did not confirm any significant prevalence for IVH development according to eNOS −786T > C genes polymorphism. Our novel investigations in EDN1 5665G > T polymorphism did not show any link between alleles or genotypes and IVH. Future investigations of polymorphisms in blood-flow associated genes may provide valuable insight into the pathogenetic mechanisms underlying the development of IVH.

Risk factors of intraventricular hemorrhage in preterm infants in the Neonatal Intensive Care Unit , University Department of Obstetrics and Gynecology, University Hospital Center Rijeka

OBJECTIVE: Intraventricular hemorrhage (IVH) is one of the most important causes of damage to the central nervous system in preterm infants. There are number of the investigated risk factors for IVH in premature infants: genetic, prenatal, delivery factors, and factors related to neonatal period. Some of them are of iatrogenic nature, suggesting the need for scientific-research approach to detect them. PATIENTS AND METHODS: We retrospectively analyzed data from medical records of Neonatal Intensive Care Unit, at the Department of Obstetrics and Gynecology, University Hospital Center Rijeka. Selected were the data on premature infants who were diagnosed with intraventricular hemorrhage (I- IV. degree), during 2013 and 2014. We analyzed the data of 60 children relating to pregnancy, childbirth and neonatal period. Subjects were divided into groups, depending on the degree of IVH, and the results were statistically analyzed. RESULTS: Chorioamnionitis during pregnancy, Apgar score at 1st and 5th minutes, perinatal asphyxia, gestational age, the presence of respiratory distress, birth weight, hyper- / hypocapnia, resuscitation, the use of fresh frozen plasma (FFP), sodium bicarbonate (NaHCO3) and the filtered red blood cells (FRBC) in the first week of life, showed a statistically significant association with the development of higher degree IVH. Factors that significantly influenced the degree of IVH are gestational age (P = 0.004) and the application of FE in the first week (P = 0.001). In explaining the degree of IVH, application of FE in the first week of life independently contributed with 11.74%, while gestational age with 7.80%.CONCLUSIONS: It is particularly important that the medical staff, which takes care of preterm newborn and pregnant woman, is familiar with the risk factors for developing IVH, particularly those of iatrogenic nature, for the purpose of their minimization and / or elimination.

Incidence and Severity of Intra-Ventricular Hemorrhage (IVH) in Preterm Infants, Northeast of Iran

Introduction: The incidence rate of Intra-Ventricular Haemorrhage (IVH) varies from 20% to 25% among preterm infants with a very low birth weight. IVH could compose critical disabilities which are directly associated to its grade. The aim of this study was to evaluate the incidence and severity of IVH in preterm infants referred to the academic Hospital of Gorgan, Northeast of Iran.Materials and Methods: In this cross-sectional study, we examined all preterm infants who had been referred to the academic Hospital of Gorgan, Northeast of Iran between Augusts 2014 and February 2015. Seventy one preterm infants (≤34 weeks of gestation, ≤1500g birth weight) have been included. Cranial ultrasound was done within 3-5 days of birth for all subjects and subsequent ultrasounds were performed based on their birth weight by portable ultrasound device.Results: The overall incidence of IVH was 64.8% in the present study. There was a significant relationship between IVH incidence and the gestational age (p=0.010). Also the lower birth weight was associated to the higher rate of IVH complications reported in sequential ultrasounds (p&lt;0.05).Conclusion: Gestational age and birth weight seem to have key roles in the occurrence and severity of IVH, respectively.J Nepal Paediatr Soc 2016;36(1):38-41

Neonatal intubation training: the patient comes first

Premature babies that require resuscitation are highly vulnerable to poor outcomes, including death, intraventricular hemorrhage, and neurodevelopmental impairment. As a result, the early minutes of neonatal resuscitation are viewed as a “golden hour” requiring technical precision and choreographed teamwork. Sauer et al used their large database of resuscitation data to show that multiple intubation attempts, particularly in the smallest babies, dramatically increased rates of intraventricular hemorrhage. As trainees typically require more attempts while learning intubation, the data from Sauer et al also suggest that delivery room resuscitation of extremely preterm babies is a poor training environment for pediatric residents. Yet, the Accreditation Council for Graduate Medical Education continues to mandate proficiency in neonatal intubation, even as the number of opportunities fall and the stakes associated with the procedure rise. Although simulation can provide some support in learning intubation mechanics, it does not fully build competency. It is time to re-examine which trainees will truly require this skill and develop novel approaches to build expertise. In the meantime, intubation training should be confined to more mature, stable, and sedated neonates. Article page 108 ▶ Intubation Attempts Increase the Risk for Severe Intraventricular Hemorrhage in Preterm Infants—A Retrospective Cohort StudyThe Journal of PediatricsVol. 177PreviewTo evaluate whether neonates exposed to multiple intubation attempts within the first 4 days after birth have an increased incidence of intraventricular hemorrhage (IVH). Full-Text PDF

Isolated Cystic Periventricular Leukomalacia Differs from Cystic Periventricular Leukomalacia with Intraventricular Hemorrhage in Prevalence, Risk Factors and Outcomes in Preterm Infants

Background: Cystic periventricular leukomalacia (cPVL) is the most severe white matter injury and is often associated with intraventricular hemorrhage (IVH) in preterm infants. Objective: The aim of this study was to investigate the prevalence, risk factors and neurodevelopmental outcomes of isolated cPVL and cPVL with low-grade and high-grade IVH in premature infants. Methods: From 2001 to 2012, 9,964 infants with <31 weeks' gestational age (GA) admitted to Taiwan hospitals were enrolled. cPVL was classified into three groups: isolated cPVL, cPVL with low-grade (I/II) IVH, and cPVL with high-grade (III) IVH. Results: Of 7,805 infants with complete ultrasound data, 286 (3.7%) had cPVL. Among the cPVL infants, 93 (32.5%) were isolated, 118 (41.3%) had low-grade IVH and 75 (26.2%) had high-grade IVH. The risk of cPVL with IVH was significantly higher among infants with <27 weeks' GA than those with ≥27 weeks' GA, in contrast to that of isolated cPVL. Using infants without cPVL and IVH as the reference group, the most significant predictor of isolated cPVL was neonatal sepsis (odds ratio 2.39; 95% confidence interval 1.52-3.77), while 5-min Apgar score <5 (2.50; 1.48-4.21) and prolonged mechanical ventilation (2.19; 1.42-3.42) were associated with cPVL with low-grade IVH, and GA <27 weeks (2.63; 1.56-4.42), pneumothorax (3.04; 1.40-6.65) and prolonged mechanical ventilation (3.36; 1.88-6.01) contributed to cPVL with high-grade IVH. cPVL infants with low-grade and high-grade IVH had a higher risk of abnormal neurodevelopmental outcomes than infants with isolated cPVL at the age of 24 months. Conclusions: Isolated cPVL, cPVL with low-grade IVH and cPVL with high-grade IVH had different risk factors and neurodevelopmental outcomes, suggestive of different causal pathways.

Risk Factors Associated with Intraventricular Hemorrhage in Preterm Infants with ≤28 Weeks Gestational Age.

To identify obstetric and neonatal risk factors associated with the development of germinal matrix-intraventricular hemorrhage (GM-IVH) in high-risk preterm neonates. Data from 279 preterm infants (246 mothers) with a gestational age≤28+0 weeks admitted to our NICU between January 2004 and December 2009 were analyzed retrospectively. Occurrence of (GM-IVH) was diagnosed by using ultrasound and important clinical variables were extracted from the patient charts. Infants were divided into 2 groups: GM-IVH and non-GM-IVH. To account for multiple gestation, generalized estimation equations (GEE) were used for univariate analysis and for the evaluation of independent risk factors. A low 5-min APGAR-Score, multiple birth, low arterial blood pressure at NICU admission, hypercapnia during the first 72 h of life in life and absence of any antenatal corticosteroids were found to be significant independent risk factors in the development of GM-IVH. Preterm infants with low arterial blood pressure, absence of antenatal corticosteroids, low 5-min APGAR-Score, higher paCO2 within the first 3 days of life and multiple gestation were at higher risk to develop GM-IVH. Avoiding these risk factors may help to decrease the rate of GM-IVH.

Intubation Attempts Increase the Risk for Severe Intraventricular Hemorrhage in Preterm Infants—A Retrospective Cohort Study

To evaluate whether neonates exposed to multiple intubation attempts within the first 4 days after birth have an increased incidence of intraventricular hemorrhage (IVH). This is a retrospective cohort study of infants intubated during the first 4 days after birth. Infants had birth weights (BWs) less than 1500 g and were admitted to the neonatal intensive care unit (NICU) at the University of California, San Diego, between January 1, 2005, and July 30, 2009. A subgroup analysis was done for infants with BW less than 750 g. A total of 308 infants with BW <1500 g, including 102 with a BW <750 g, were intubated within the first 4 days of life. The number of intubation attempts was significantly greater in infants with a BW <750 g who had severe IVH compared with those with mild or no IVH (OR 1.395, 95% CI 1.090-1.786, P = .008). For infants with BW <1500 g, the number of intubation attempts in the delivery room was significantly greater for infants with severe IVH (OR 1.317, 95% CI 1.052-1.649, P = .016). Increased intubation attempts were associated with increased incidence of severe IVH in infants with BW less than 750 g and in infants less than 1500 g who were intubated only in the delivery room. Prospective studies are needed to further evaluate the relationship between intubation attempts and severe IVH.

Risk Factors, Diagnosis, and Current Practices in the Management of Intraventricular Hemorrhage in Preterm Infants: A Review

Risk Factors, Diagnosis, and Current Practices in the Management of Intraventricular Hemorrhage in Preterm Infants: A Review

Ventilation of Preterm Infants during Delayed Cord Clamping (VentFirst): A Pilot Study of Feasibility and Safety.

Background Establishing lung inflation prior to umbilical cord clamping may improve the cardiovascular transition and reduce the risk of intraventricular hemorrhage in preterm infants. We developed a pilot feasibility and safety study in which infants < 33 weeks' gestation received assisted ventilation during delayed cord clamping (DCC). Methods Infants born between 24 0/7 and 32 6/7 weeks' gestation whose mothers consented were enrolled. All infants received continuous positive airway pressure or positive pressure ventilation during 90 seconds of DCC. Outcomes included feasibility (ability to complete protocol and maintain a sterile field during cesarean deliveries) and safety variables (Apgar scores, umbilical cord pH and base deficit, admission temperature, and postcesarean infection). Results A total of 29 infants were enrolled, including one set of twins (median gestation: 30 weeks; 72% cesarean births). In all cases, the protocol was completed. Heart rate at 60 seconds was more than 100 beats per minute in all infants. Apgar scores, cord blood gas values, and admission temperature were comparable to other preterm deliveries at our institution. Conclusion Assisting ventilation of very preterm infants during 90 seconds of DCC is challenging but feasible and appears to be safe in this small pilot study. A randomized clinical trial is warranted to determine clinical benefit.

Heparin for the prevention of intraventricular haemorrhage in preterm infants.

Preterm birth remains the major risk factor for the development of intraventricular haemorrhage, an injury that occurs in 25% of very low birth weight infants. Intraventricular haemorrhage is thought to be venous in origin and intrinsic thromboses in the germinal matrix are likely to play a triggering role. Heparin activates antithrombin and promotes the inactivation of thrombin and other target proteinases. The administration of anticoagulants such as heparin may offset the increased risk of developing intraventricular haemorrhage and may also reduce the risk of developing parenchymal venous infarct, a condition known to complicate intraventricular haemorrhage. To assess whether the prophylactic administration of heparin reduces the incidence of germinal matrix-intraventricular haemorrhage in very preterm neonates when compared to placebo, no treatment, or other anticoagulants. We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2015), MEDLINE (1996 to 22 November 2015), EMBASE (1980 to 22 November 2015) and CINAHL (1982 to 22 November 2015), applying no language restrictions. We searched the abstracts of the major congresses in the field (Perinatal Society of Australia and New Zealand and Pediatric Academic Societies) from 2000 to 2015. Randomised controlled trials, quasi-randomised controlled trials and cluster trials comparing the administration of early, i.e. within the first 24 hours of life, heparin in very preterm infants (gestational age < 32 weeks). For each of the included trials, two authors independently extracted data (e.g. number of participants, birth weight, gestational age, dose of heparin, mode of administration, and duration of therapy, etc.) and assessed the risk of bias (e.g. adequacy of randomisation, blinding, completeness of follow up). The primary outcomes considered in this review are intraventricular haemorrhage, severe intraventricular haemorrhage and neonatal mortality. Two randomised controlled trials enrolling a total of 155 infants met the inclusion criteria of this review. Both trials compared low-dose heparin to the same solution without heparin in very preterm newborns requiring umbilical catheterisation. No trials were identified that specifically studied the use of heparin in infants at risk of germinal matrix-intraventricular haemorrhage.We found no differences in the rates of intraventricular haemorrhage (typical RR 0.93, 95% CI 0.61 to 1.41; typical RD -0.03, 95% CI -0.17 to 0.12; 2 studies, 155 infants; I² = 57% for RR and I² = 65% for RD), severe intraventricular haemorrhage (typical RR 1.01, 95% CI 0.46 to 2.23; typical RD 0.00, 95% CI -0.11 to 0.11; 2 studies, 155 infants; I² = 0% for RR and I² = 0% for RD) and neonatal mortality (typical RR 0.69, 95% CI 0.28 to 1.67; typical RD -0.04, 95% CI -0.14 to 0.06; 2 studies, 155 infants; I² = 28% for RR and I² = 50% for RD). We judged the quality of the evidence supporting these findings as very low (rates of intraventricular haemorrhage) and low (severe intraventricular haemorrhage and neonatal mortality) mainly because of limitations in the study designs and the imprecision of estimates. We found very few data on other relevant outcomes, such as bronchopulmonary dysplasia, pulmonary haemorrhage and patent ductus arteriosus; and no study assessing long-term outcomes (e.g. neurodevelopmental disability). There is very limited data on the effect of prophylactic administration of heparin on the incidence and severity of IVH in very preterm neonates. Both the identified trials used heparin in the context of maintaining umbilical line patency and not specifically as an agent to prevent germinal matrix-intraventricular haemorrhage. Given the imprecision of our estimates, the results of this systematic review are consistent with either a benefit or a detrimental effect of heparin and do not provide a definitive answer to the review question. Limited evidence is available on other clinically relevant outcomes.

Evaluating an Association between Ampicillin and Intraventricular Hemorrhage in Preterm Infants.

Intraventricular hemorrhage (IVH) is a common and potentially devastating adverse outcome affecting up to 30% of preterm infants. β-Lactam antibiotics affect platelet activation through interaction with platelet surface receptors. The objective of this study was to evaluate an association between ampicillin use and the development of IVH in preterm infants. This was a single-center and a retrospective case-control study of preterm low-birth-weight infants diagnosed with IVH and matched controls without IVH. Conditional logistic regression was performed on 10 clinical features from the first week of life to evaluate the association with IVH. Data were obtained for 174 subjects with no significant differences between groups in demographic factors and level of illness indicators. Earlier administration of the first dose of ampicillin was associated with increased odds of developing IVH (odds ratio [OR]: 0.95, p = 0.028) when controlling for other common associations. Longer courses of ampicillin were not significantly associated with the development of IVH (OR: 1.13, p = 0.089). The odds of developing IVH in our population increased with earlier, but not longer initial courses of ampicillin. Further research into the associations with IVH should include the assessment of ampicillin dose, timing, and duration.

Elevated Diastolic Closing Margin Is Associated with Intraventricular Hemorrhage in Premature Infants

To determine whether the diastolic closing margin (DCM), defined as diastolic blood pressure minus critical closing pressure, is associated with the development of early severe intraventricular hemorrhage (IVH). A reanalysis of prospectively collected data was conducted. Premature infants (gestational age 23-31weeks) receiving mechanical ventilation (n=185) had ∼1-hour continuous recordings of umbilical arterial blood pressure, middle cerebral artery cerebral blood flow velocity, and PaCO2 during the first week of life. Models using multivariate generalized linear regression and purposeful selection were used to determine associations with severe IVH. Severe IVH (grades 3-4) was observed in 14.6% of the infants. Irrespective of the model used, Apgar score at 5minutes and DCM were significantly associated with severe IVH. A clinically relevant 5-mm Hg increase in DCM was associated with a 1.83- to 1.89-fold increased odds of developing severe IVH. Elevated DCM was associated with severe IVH, consistent with previous animal data showing that IVH is associated with hyperperfusion. Measurement of DCM may be more useful than blood pressure in defining cerebral perfusion in premature infants.

Risk Factors for Intraventricular Hemorrhage in Preterm Infants Born at 34 Weeks of Gestation or Less Following Preterm Premature Rupture of Membranes

The objective of this study is to identify possible perinatal risk factors related to intraventricular hemorrhage (IVH) in preterm infants born at 34 weeks of gestation or less following preterm premature rupture of membranes (pPROM). A total of 292 preterm infants born at 34 weeks of gestation or less following pPROM were enrolled in the study, while 155 newborns with incomplete data, especially those that lack histological examination of the placenta, maternal details, and neonatal characteristics, have been further excluded. Finally, data of 137 preterm infants were included in the analysis. All infants underwent ultrasonographic screening for IVH. Thirty-three infants with IVH were considered as cases and 104 infants without IVH were considered as controls. The association between risk factors and IVH was evaluated by univariate and multivariate logistic regression analyses. The incidence of IVH in preterm infants born at 34 weeks of gestation or less following pPROM was 24.1%, while the incidence of maternal chorioamnionitis was 43.8%. By univariate analysis, gestational age, birth weight, asphyxia resuscitation, maternal chorioamnionitis, fetal distress, amniotic fluid index, and latency of the rupture of membranes to birth were found to be significantly different between the 2 groups. By logistic regression analysis, lower gestational age, low birth weight, asphyxia resuscitation, and maternal chorioamnionitis were found to be independent risk factors for IVH. Lower gestational age, low birth weight, asphyxia resuscitation, and maternal chorioamnionitis are independent risk factors for IVH in preterm infants born at 34 weeks of gestation or less following pPROM.