Prevalence and risk factors of intraventricular hemorrhage in Very low birth weight infants at Chris Hani Baragwanath academic hospital

Abstract

Background: Intraventricular hemorrhage (IVH) is the commonest form of bleeding in the central nervous system (CNS) of premature neonates. Pathogenesis is attributed to germinal matrix fragility. Risk factors are multifactorial and related to various events that may happen in utero, peri-partum and postnatally. Methods: This was a retrospective descriptive study in the neonatal unit of CHBAH. 529 VLBW infants of <1500g admitted between January 2017 to December 2018 were studied. Those with IVH were cases and those without IVH were controls. Results: Of the 529 infants studied, 33%(n=176) had IVH, 56% (n=99) were mild IVH (grade 1 and 2) and 44% (n=77) were severe IVH (grade 3 and 4). Median gestational age (28 vs 30, p<0.001) and birthweight (1059g vs 1220g, p<0.001) were lower in those with IVH. More neonates with no IVH received steroids (40.5% vs 30.1%, p=0.020) and magnesium sulphate (11.9% vs 2.8%, p<0.001). Neonates with an Apgar score < 6 at 5 minutes (OR 8.17, 95%CI: 2.54-26.3), intubated (OR 8.822, 95%CI: 1.34-56.41) and had meningitis (OR 104.92, 95%CI: 40.10 -274.5) were more likely to have IVH. Those with IVH had a 20-fold chance of having PHHC (OR 20.25, 95%CI: 1.21 -338.84) and a higher likelihood of dying (3.70 95% CI 1.50-9.15). PHHC was observed in neonates who had severe IVH (grade 3 and 4). Of the neonates who died IPPV (2.20, 95% CI 1.117-4.34), hypotension (10.46, 95% 2.32-47.11) and meningitis (1.13, 95% 1.016-1.26) were associated with death. Conclusion: Incidence of IVH is consistent with those of LMIC. The significant risk factors for IVH were low Apgar score at 5 minutes, those who were intubated, and had meningitis. Steroids and magnesium sulphate were protective against developing IVH. More studies are needed to analyze risk factors associated with severe IVH (grade 3 and 4). Identifying pharmacological neuroprotective agents may be beneficial in future.