Intraventricular Hemorrhage In Infants Research Articles

Neonatal ventriculomegaly: Pathophysiology and management guided with cranial ultrasonography.

Neonatal ventriculomegaly often, but not always, follows intraventricular haemorrhage in infants born preterm. Serial cranial ultrasonography (CUS) is a very useful tool to evaluate the mechanism behind ventricular dilatation, to differentiate several types of cerebrospinal fluid retention, and to guide treatment. This review examines neonatal ventriculomegaly and its definition, pathophysiology, treatment, and prognosis from the perspective of CUS assessment. It also outlines the consensus statements formulated by the EurUS.Brain group, which are based on rounds of expert opinions on neonatal ventriculomegaly management, detailing the need and timing of ventricular access device placement, in the context of posthaemorrhagic ventricular dilation. The pathophysiology of neonatal ventriculomegaly is more complex than previously considered. CUS is a valuable, non-invasive tool to determine pathophysiology, intervention thresholds, and prognosis in neonates with ventriculomegaly. Given new insights into the existence of glymphatics and water circulation in the cerebrum, further research in that area may bring new treatment options.

Does clamping the umbilical cord >30 seconds after birth decrease intraventricular hemorrhage in infants born before 37 weeks?

Does clamping the umbilical cord >30 seconds after birth decrease intraventricular hemorrhage in infants born before 37 weeks?

Does Antenatal Progesterone Administration Modify the Risk of Neonatal Intraventricular Hemorrhage?

Progesterone administration has been associated with improved neurological outcomes following traumatic brain injury in adults. However, studies examining the effect of progesterone on the risk of neonatal intraventricular hemorrhage (IVH) are inconsistent. We sought to determine if maternal administration of intramuscular 17-α-hydroxyprogesterone caproate (17-OHPC) is associated with decreased rates of IVH in infants born before 32-weeks gestation. This is a retrospective study of liveborn singleton deliveries between 20- and 32-weeks gestation at two large academic medical centers from January 1, 2012 to August 30, 2020. Data were extracted from hospital electronic medical record data warehouses using standardized definitions and billing and diagnosis codes. We evaluated receipt of 17-OHPC in the antepartum period and diagnosis of IVH (grade I-IV, per Volpe classification) during the neonatal delivery hospitalization encounter. Bivariate and multivariate analyses were performed to examine the association between 17-OHPC and neonatal IVH adjusting for potential confounders. Odds ratio (ORs) and 95% confidence intervals (CIs) were presented. Among 749 neonates born between 20- and 32-week gestation, 140 (18.7%) of their mothers had received antenatal 17-OHPC and 148 (19.8%) were diagnosed with IVH after birth. No significant association was observed between maternal 17-OHPC and neonatal IVH in unadjusted (OR 1.14, 95% CI 0.72-1.78) or adjusted analyses (adjusted odds ratio 1.14, 95% CI 0.71-1.84). Independent of exposure to 17-OHPC, as expected, infants born <28-weeks gestation or those with very low birthweight (<1,500 g) were at an increased risk of IVH (OR 2.32, 95% CI 1.55-3.48 and OR 2.19, 95% CI 1.09-4.38, respectively). Antenatal maternal 17-OHPC administration was not associated with the risk of neonatal IVH. Further research may be warranted to determine whether timing, route of delivery, and duration of progesterone therapy impact rates of neonatal IVH. · This study aimed to compare the frequency of intraventricular hemorrhage in preterm neonates exposed to antenatal 17-α-hydroxyprogesterone caproate to those not exposed.. · In neonates born at <32-weeks gestation, maternal use of progesterone is not associated with the risk of intraventricular hemorrhage.. · In contrast to preclinical and adult data, this study suggests that progesterone exposure is not associated with the prevention of neonatal brain injury..

HFOV vs CMV for neonates with moderate-to-severe perinatal onset acute respiratory distress syndrome (NARDS): a propensity score analysis.

This study aimed to evaluate whether high-frequency oscillatory ventilation (HFOV) could reduce mortality and the incidence of bronchopulmonary dysplasia (BPD) of perinatal-onset neonatal acute respiratory distress syndrome (NARDS) compared with conventional mechanical ventilation (CMV). Medical records were collected and retrospectively analyzed. Among the 700 neonates with NARDS who needed invasive ventilation, 501 (71.6%) received CMV, while 199 (28.4%) received HFOV. One-to-one propensity score matching (127:127) was used to match the baseline characteristics of patients who received CMV and HFOV. The results showed that birth weight and oxygenation index (OI) were independently associated with mortality in the multivariate logistic regression. No significant differences were observed in mortality or the incidence of BPD between the two groups. The incidence of intraventricular hemorrhage (IVH) and ventilation-free days were significantly lower in the HFOV group than in the CMV group (3.9 vs 11.80%, p=0.02; 15.226 vs 20.967 days, p=0.01). There were no significant differences between the two groups regarding other secondary outcomes.Conclusion: HFOV was associated with a decreased incidence of IVH in infants with NARDS compared with CMV. However, there were significantly more VFDs in the CMV group than in the HFOV group, and HFOV did not appear to be superior to CMV in decreasing the mortality and incidence of BPD in infants with NARDS.What is Known:• The diagnostic criteria of neonatal acute respiratory distress syndrome (Montreux criteria) were established in 2017.• To date, studies comparing high-frequency oscillatory ventilation and conventional mechanical ventilation in the treatment of neonatal acute respiratory distress syndrome are insufficient.What is New:• High-frequency oscillatory ventilation did not appear to be superior to conventional mechanical ventilation in decreasing the mortality and incidence of bronchopulmonary dysplasia in infants with moderate-to-severe perinatal-onset neonatal acute respiratory distress syndrome.• High-frequency oscillatory ventilation was associated with a decreased incidence of intraventricular hemorrhage in infants with moderate-to-severe perinatal-onset acute respiratory distress syndrome compared with conventional mechanical ventilation.

School-age outcomes following intraventricular haemorrhage in infants born extremely preterm

ObjectiveTo determine the associations of different grades of intraventricular haemorrhage (IVH), particularly grades 1 and 2, with neurodevelopmental outcomes at 8 years of age in children born extremely preterm.DesignPopulation-based cohort...

Early Cardiac and Cerebral Hemodynamics with Umbilical Cord Milking Compared with Delayed Cord Clamping in Infants Born Preterm

To evaluate changes in cerebral oxygenation, peripheral arterial oxygenation, respiratory status, and administered fraction of inspired oxygen during the first 10minutes of life in premature infants receiving umbilical cord milking compared with delayed cord clamping (DCC). Premature infants born at 230/7 to 276/7weeks of gestation were randomized to umbilical cord milking or DCC. A near infrared spectroscopy sensor, pulse oximeter, and electrocardiogram electrodes were placed. Pulse rate, cerebral tissue oxygenation, peripheral oxygen saturation, airway pressure, and fraction of inspired oxygen were collected for 10minutes in the delivery room. Longitudinal models were used to compare effects of umbilical cord milking and DCC. Fifty-six infants had cerebral oximetry and advanced monitoring at birth. There was an increased incidence of severe intraventricular hemorrhage in infants who received umbilical cord milking compared with DCC (P=.0211). Longitudinal models suggested that peripheral oxygen saturation was higher in the umbilical cord milking group in the first 4minutes (P=.0221) and that mean airway pressures were lower in the umbilical cord milking group after the first 7minutes (P=.0072). No statistical differences were observed for fraction of inspired oxygen, cerebral tissue oxygenation, or heart rates. The data suggest that the rapid transfer of blood during umbilical cord milking may facilitate lung expansion with improved pulmonary blood flow, but may also increase cerebral blood flow, resulting in severe intraventricular hemorrhage. ClinicalTrials.gov: NCT03145142.

Metabolic acidosis rather than hypo/hypercapnia in the first 72 hours of life associated with intraventricular hemorrhage in preterm neonates

Aim Safe limits of arterial partial pressure of carbon dioxide (PaCO2) and acidosis in premature infants are not well defined. Both respiratory and systemic illness along with center-specific ventilation strategies contribute to PaCO2 fluctuations and acid–base imbalances during the critical time period of first 72 h of life. This study evaluated the association between early blood gas parameters and intraventricular hemorrhage (IVH) in preterm infants. Methods This retrospective observational study included neonates with a gestational age (GA) of ≤29 wks, who had at least 7 blood gas analysis done within the first 72 h of life. By adjusting for known variables that predispose to IVH, multivariable logistic regression analysis was used to study the association of PaCO2 and acid–base measures with the risk of IVH. Results Between 2013–2016, among 272 neonates who met inclusion criteria and were assessed for IVH on cranial ultrasound within first week of life, 101 neonates [mean GA of 25 ± 1.5 wks] had IVH and 171 neonates [mean GA of 25 ± 1.6 wks] had normal scans. After adjustment for confounding variables, higher values of maximum lactate (OR = 1.18, 95% CI = 1.1–1.3, p < .0001) and maximum base deficit (OR = 1.19, 95% CI = 1.1–1.2, p < .0001) within 72 h of life increased the likelihood of any grade of IVH. However, time-weighted average PaCO2, maximum and minimum PaCO2 had no statistically significant effect on the risk of IVH. The relationship remained unchanged even when moderate–severe IVH was considered as the primary outcome. Conclusion Severe metabolic acidosis rather than hypo/hypercapnia during the first 72 h of life was associated with higher odds of IVH in infants born at ≤29 wks of gestation. Future studies determining levels of PaCO2 that is safe for premature brain would need to control for the metabolic component of acidosis.

Elevated International Normalized Ratio (INR) is Associated With an Increased Risk of Intraventricular Hemorrhage in Extremely Preterm Infants.

The international normalized ratio (INR), a standardized method of reporting the prothrombin time, can be a surrogate marker of the vitamin K-dependent coagulation pathways. To evaluate the relationship between INR measurements in the first 48 hours of life and subsequent development of intraventricular hemorrhage (IVH) in extremely preterm infants. A single-center retrospective, observational cohort study of infants born at <28 weeks gestation. The main outcome measure was defined as the degree of IVH seen on cranial ultrasound examinations at day 7 postnatal age. Of 200 infants, 109 (mean gestational age, 25.2 wk [SD, 1.27]) had coagulation results available. Of 109, 26 developed IVH. Elevated INR was associated with increased risk of a severe IVH (odds ratio [OR] 6.50; 95% confidence interval [CI], 1.65-25.62; P=0.008) adjusted for gestation, birth weight, and sex. INR was significantly associated with severe IVH in infants who did not receive blood products (OR, 64.60; 95% CI, 1.35-3081.25; P=0.035), but not in those who did (OR, 2.93; 95% CI, 0.67-12.71; P=0.151) (Pinteraction=0.086). An elevated INR in the first 48 hours of life may be useful to identify preterm infants at risk of severe IVH and may guide strategies to prevent the development, or limit the extension, of IVH.

Treatment of intraventricular hemorrhage in infants

Intraventricular hemorrhage (IVH) is a disorder of the central nervous system, which is most frequently diagnosed in newborns. The disorder occurrence and development are related to the gestation age and weight of a newborn. IVH arises in 30 % of newborns with weight under 1500 g and develops on the 2 nd — 3 rd day after birth. Fifty-five percent of newborns present a neurological deficit following IVH, 30 % of patients with IVH have a permanent disability in early childhood and 70 % — at a different age. Premature newborns with IVH of III–IV grade have a high risk of developing posthemorrhagic hydrocephalus (PHH), cerebral palsy and mental disturbances. Literature review and analysis of the world major medical databases (MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, PubMed) of etiology, pathogenesis, treatment of IVH in infants illustrate advantages and limitations of the various methods for the control of intracranial hypertension associated with IVH and PHH. Gold standard and method of permanent control of intracranial hypertension — ventriculoperitoneal shunting frequently requires temporary control of the intracranial pressure and has limitations in this category of patients. Considering that there is no the only correct way of treatment of IVH and PHH, and recognizing disadvantages for each method of temporary and permanent draining of the CSF, the interventions should focus on the early clearing of the CSF pathways. Among proposed techniques, neuroendoscopic lavage is worthy of special attention, because it is associated with a lower rate of infectious complications and need in subsequent neurosurgical interventions according to the research results. Considering the pathogenesis of PHH development and treatment results, techniques of neuroendoscopic lavage need to be further researched and implemented in the list of neurosurgical procedures for the children with IVH in Ukraine.

Investigation of the relationship between umbilical cord pH and intraventricular hemorrhage of infants delivered preterm.

We measured the level of pH gases in premature infants at birth, and examined the relationship between brain ultrasonography on the third and seventh day after birth. A case-control study conducted at the Neonatal Intensive Care Unit (NICU) of Shahid Akbar Abadi Hospital, Iran, during the years 2016-2017. All premature infants who were admitted to NICU were enrolled in the current study. At birth, a blood gas sample was taken from the umbilical cord of the infants. On the third and seventh day after birth, an ultrasound of the brain of each neonate was performed by a radiologist. The umbilical cord was evaluated for blood gases in 72 neonates (mostly boys). Sixty-six newborns had normal sonography, and 16.7% (12 cases) had anomalies. A total of 75% of the 8 infants with intravenous bleeding were girls, which were significantly different from those in the non-hemodynamic group (62.5% male) (P 0.049). However, the type of delivery, mean weight, height, head circumference, the circumference of the chest, and Apgar score did not differ between the two groups. Mean pH, HCO3- and PCO2 in umbilical cord blood gas samples were not significantly different between the two groups with or without intraventricular hemorrhage (IVH). Although it was not related to gender and type of delivery in newborns. Blood gases do not help in determining the occurrence of IVH in infants. Nevertheless, it is associated with immaturity and fetal age.

LB 1: Premature Infants Receiving Cord Milking or Delayed Cord Clamping: A Randomized Controlled Non-inferiority Trial

Umbilical cord milking (UCM) might be an alternative to delayed cord clamping (DCC) to provide additional blood to preterm infants without delaying resuscitation. There are limited safety data with UCM in extremely premature infants. Multi-national, randomized controlled non-inferiority trial enrolled preterm infants of 23-31 weeks gestation. Infants were randomized to either UCM (4 times) or DCC (at least 60 seconds) stratified by mode of delivery and gestational age, lower gestational age (GA) strata: 23 -27 weeks and higher GA strata: 28 - 31 weeks gestation. Exclusions - major congenital anomalies, severe placental abruption, trans-placental incisions, cord prolapse, hydrops, bleeding accreta, monochorionic multiples, fetal or maternal risk for severe compromise at delivery, and families unlikely to return for 24-month neurodevelopmental testing. Contingent on local IRBs, consent was obtained either before or after delivery. The composite primary outcome included severe intraventricular hemorrhage (IVH) or death in the entire group (23-31 weeks). Severe IVH was defined as grade 3 or higher. We planned to enroll 1500 infants (750 per group) to achieve 90% power to demonstrate non-inferiority with a 1% non-inferiority margin based on a 1-sided 95% confidence interval. 474 infants were enrolled from June 2017 through August 2018. 19/238 (8%) of infants randomized to DCC died or developed severe IVH, compared to 28/236 (12%) randomized to UCM (p=0.16). There was no difference in death between the two groups. However, the incidence of severe IVH was higher in the lower GA strata in the UCM group (22% vs 4%, p=0.0007). Following an interim assessment, the DSMB recommended stopping recruitment based on the safety outcome of increased severe IVH in infants randomized to UCM in the lower GA strata. In this strata there were no differences in maternal and delivery characteristics (Table 1). The neonatal outcomes for the lower strata are presented in Table 2. In extremely premature infants, there was an increased risk of severe IVH after exposure to UCM. Centers practicing UCM should consider discontinuing this practice in infants 23-27 weeks gestation.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Apolipoprotein E gene polymorphisms and intraventricular haemorrhage in infants born preterm: a large prospective multicentre cohort study.

Infants born preterm are at risk of intraventricular haemorrhage (IVH) but individual susceptibility related to genes is not well defined in this vulnerable population. Apolipoprotein genotypes APOE2 and APOE4 increase the hazard of cerebral haemorrhages in adults. We investigated whether APOE is associated with prevalence of IVH and is likely to have a particular genotype. In this prospective study, 5075 infants born preterm with genotype APOE3 were compared to 965 (APOE2) and 1912 (APOE4) individuals, to analyse the association between APOE genotype and grade III and IV IVH. We used a logistic regression model including gestational age, antenatal steroid treatment, 5-minute Apgar scores less than 3, intubation, pneumothorax, small for gestational age, multiple birth, sex, and maternal descent as independent factors. The APOE2 (20.1%) and APOE4 (19.8%) genotypes were significantly more prevalent in infants with IVH than in those with the APOE3 haplotype (17.4%) (APOE2: odds ratio [OR] 1.33, 95% confidence interval [CI] 1.00-1.76; APOE4: OR 1.39, 95% CI 1.12-1.74). Infants with two polymorphisms had the highest risk of IVH (8.7%; OR 1.63, 95% CI 1.09-2.45). APOE2 and APOE4 genotypes are relevant risk factors for IVH in infants born preterm. Our findings improve our understanding of the genetic contributions to IVH.

Intraventricular Hemorrhage in Moderate to Severe Congenital Heart Disease.

Determine the prevalence of intraventricular hemorrhage in infants with moderate to severe congenital heart disease, investigate the impact of gestational age, cardiac diagnosis, and cardiac intervention on intraventricular hemorrhage, and compare intraventricular hemorrhage rates in preterm infants with and without congenital heart disease. A single-center retrospective review. A tertiary care children's hospital. All infants admitted to St. Louis Children's Hospital from 2007 to 2012 with moderate to severe congenital heart disease requiring cardiac intervention in the first 90 days of life and all preterm infants without congenital heart disease or congenital anomalies/known genetic diagnoses admitted during the same time period. None. Cranial ultrasound data were reviewed for presence/severity of intraventricular hemorrhage. Head CT and brain MRI data were also reviewed in the congenital heart disease infants. Univariate analyses were undertaken to determine associations with intraventricular hemorrhage, and a final multivariate logistic regression model was performed. There were 339 infants with congenital heart disease who met inclusion criteria and 25.4% were born preterm. Intraventricular hemorrhage was identified on cranial ultrasound in 13.3% of infants, with the majority of intraventricular hemorrhage being low-grade (grade I/II). The incidence increased as gestational age decreased such that intraventricular hemorrhage was present in 8.7% of term infants, 19.2% of late preterm infants, 26.3% of moderately preterm infants, and 53.3% of very preterm infants. There was no difference in intraventricular hemorrhage rates between cardiac diagnoses. Additionally, the rate of intraventricular hemorrhage did not increase after cardiac intervention, with only three infants demonstrating new/worsening high-grade (grade III/IV) intraventricular hemorrhage after surgery. In a multivariate model, only gestational age at birth and African-American race were predictors of intraventricular hemorrhage. In the subset of infants with CT/MRI data, there was good sensitivity and specificity of cranial ultrasound for presence of intraventricular hemorrhage. Infants with congenital heart disease commonly develop intraventricular hemorrhage, particularly when born preterm. However, the vast majority of intraventricular hemorrhage is low-grade and is associated with gestational age and African-American race.

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.

The role of FV 1691G>A, FII 20210G>A mutations and MTHFR 677C>T; 1298A>C and 103G>T FXIII gene polymorphisms in pathogenesis of intraventricular hemorrhage in infants born before 32 weeks of gestation

BackgroundCongenital thrombophilia is associated with an increased intraventricular hemorrhage (IVH) risk among newborns, but it may also play a protective role. The role of genetic polymorphisms involved in the coagulation pathway of IVH pathogenesis is probably a consequence of an increased risk of thrombosis in the fine blood vessels in the germinal matrix region.Material and methodsThe aim of this study was to evaluate the possible relationship between Factor V (FV) 1691G>A, Factor II (FII) 20210G>A mutations and methylenetetrahydrofolate reductase (MTHFR) 677C>T; 1298A>C and Factor XIII (FXIII) 103G>T gene polymorphisms and the occurrence of IVH in 100 infants born from 24 + 0 to 32 + 0 weeks of gestation, born from singleton pregnancy, before 32 + 0 weeks of gestation, exposed to antenatal steroid therapy, and without congenital abnormalities.ResultsIVH developed 45 (45%) infants, including 15 (33.33%) diagnosed with IVH stage I, 20 (42.22%) with stage II, 8 (17.77%) with stage III, and 3 (6.66%) with stage IV. Analysis showed a prevalence 4.5 times higher of IVH stages II to IV in infants with the genotype CC (OR 4511 (1147–17.75);p = 0.026) of MTHFR 1298A>C gene polymorphism. Our investigation did not confirm any significant prevalence of IVH development in other studied mutations/polymorphisms.ConclusionsThis study confirmed that the MTHFR 1298A>C polymorphism is associated with the risk of IVH. IVH is a significant problem for preterm infants. In addition to little progress in preventing IVH in preterm babies, substantial research that is focused on understanding the etiology, mechanism, and risk factors for IVH is imperative. In the era of personalized medicine, identification of genetic risk factors creates opportunities to generate preventative strategies.

Antenatal Betamethasone: A Prolonged Time Interval from Administration to Delivery Is Associated With an Increased Incidence of Severe Intraventricular Hemorrhage in Infants Born Before 28 Weeks’ Gestation

(Abstracted from J Pediatr 2016;177:114–120) Studies, including several randomized controlled trials, have reported that neonates exposed to antenatal corticosteroids have reduced incidence of death, respiratory distress syndrome (RDS), and severe grades of intraventricular hemorrhage (IVH). The present study aimed to investigate the effects of antenatal corticosteroids on severe IVH in infants born at less than 28 weeks’ gestation based on the hypothesis that the beneficial effects of antenatal steroids on severe IVH diminish with time in these infants and that retreatment with a second course of antenatal betamethasone (BMZ) can restore its beneficial effects.

Antenatal Betamethasone: A Prolonged Time Interval from Administration to Delivery Is Associated with an Increased Incidence of Severe Intraventricular Hemorrhage in Infants Born before 28 Weeks Gestation

To examine the effects of antenatal steroids on severe intraventricular hemorrhage (IVH) in infants born during the IVH vulnerable period (<28 weeks gestational age) and to evaluate rates of IVH correlated with the time interval between treatment or retreatment and birth. A total of 429 infants (<28 weeks gestation), who delivered ≥24 hours after the first betamethasone (BMZ) course (2 doses), were divided into groups based on the interval between the first course of BMZ and delivery: <10 days or ≥10 days. The primary outcome was severe IVH. Multiple regression analyses were performed to adjust for potential confounders. Three hundred ninety-two infants delivered after a single BMZ course (312 delivered <10 days; 80 ≥10 days). The incidence of severe IVH was 17% for infants delivered ≥10 days and 7% for those delivered <10 days after a single BMZ course (aOR 4.16; 95% CI 1.59-10.87, P = .004); 37 infants (born ≥10 days from the first BMZ course) received a second/rescue BMZ course. The incidence of severe IVH among infants receiving a second/rescue course was 8%, which was similar to the incidence among infants born <10 days (aOR 1.7; 95% CI 0.41-6.6, P = .48). In infants born before 28 weeks gestation, delivery ≥10 days from the first BMZ course is associated with a higher incidence of severe IVH; a second/rescue course may reverse this effect.

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.

IMPROVED NEUROLOGICAL ASSESSMENT OF SEVERE INTRAVENTRICULARHEMORRHAGE IN NEWBORNS WITH VERY LOW AND EXTREMELY BIRTH WEIGHT

Neurological outcomes in severe intraventricular hemorrhage in infants with very prematurity de- termined by correctable and uncorrectable factors of bleeding. The aim of the study was to develop an optimal clinical diagnostic algorithm in selection of treatment of severe intraventricular hemorrhage in infants born with critical immaturity. During the period 2005-2010. He received treatment at the hospi- tal in 1150 infants with very low birth weight (VLBW), and extremely low birth weight (ELBW). We used clinical methods of evaluation: neurological examination, pediatric Glasgow Coma Scale / Saint Petersburg (Iova A.S. et al., 1999). Diagnostic methods: ulrasonografiya (US), computed tomography (CT), magnetic resonance imaging (MRI).Ways of improving diagnostic tactics depending on the risk factors and the dynamic clinical and ultrasonographic evaluation. Adoption subgaleal drainage when post-hemorrhagic ventriculodilatation improves early neurological outcomes in children.

Thrombocytopaenia and intraventricular haemorrhage in very premature infants: a tale of two cities

ObjectiveTo study whether the incidence of intraventricular haemorrhage (IVH) in very premature infants (<32 weeks gestation) with thrombocytopaenia is lower when using a liberal platelet-transfusion guideline compared with a restrictive...