J Korean Med Sci.  2010 Mar;25(3):418-424. 10.3346/jkms.2010.25.3.418.

Risk Factors for Periventricular-Intraventricular Hemorrhage in Premature Infants

• Lee JY
• Kim HS
• Jung E
• Kim ES
• Shim GH
• Lee HJ
• Lee JA
• Choi CW
• Kim EK
• Kim BI
• Choi JH

• KMID: 1778037
• DOI: http://doi.org/10.3346/jkms.2010.25.3.418

Abstract

Periventricular-intraventricular hemorrhage (PV-IVH) is a major cause of neurological disabilities in preterm newborns. This study aimed to determine the perinatal factors associated with PV-IVH. We conducted a retrospective case-control study from preterm infants born at < or =34 weeks of gestation and admitted to Neonatal Intensive Care Units of Seoul National University Children's Hospital and Seoul National University Bundang Hospital between June 2003 and December 2007. Neonates with no cranial sonographic data or infants transferred from other centers after three days of age were excluded. Of 1,044 eligible subjects, 59 infants with PV-IVH grade 2, 3, and 4 were allocated to the case group. The control group consisted of 118 infants without PV-IVH who were matched for gestational age and birth weight to each case of PV-IVH. At the multivariate logistic regression model, metabolic acidosis (odds ratio [OR]: 6.94; 95% confidence interval [CI]: 1.12-43.23) and use of inotropes (OR: 3.70; 95% CI: 1.16-11.84) were associated with an increased risk of PV-IVH. Maternal use of antenatal corticosteroids decreases the risk of PV-IVH (OR: 0.36; 95% CI: 0.14-0.92).

Keyword

Intracranial Hemorrhages; Infant, Premature; Intensive Care, Neonatal; Risk Factors

MeSH Terms

Acidosis/complications
Adult
Birth Weight
Cardiotonic Agents/adverse effects
Case-Control Studies
Cerebral Hemorrhage/*etiology/pathology
Female
Gestational Age
Humans
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases/*etiology/pathology
Male
Odds Ratio
Pregnancy
Retrospective Studies
Risk Factors
Cardiotonic Agents

Reference

1. Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR, Bauer CR, Donovan EF, Korones SB, Laptook AR, Lemons JA, Oh W, Papile LA, Shankaran S, Stevenson DK, Tyson JE, Poole WK. Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol. 2007. 196:147.

2. Kusuda S, Fujimura M, Sakuma I, Aotani H, Kabe K, Itani Y, Ichiba H, Matsunami K, Nishida H. Morbidity and mortality of infants with very low birth weight in Japan: center variation. Pediatrics. 2006. 118:e1130–e1138.

3. Heuchan AM, Evans N, Henderson Smart DJ, Simpson JM. Perinatal risk factors for major intraventricular haemorrhage in the Australian and New Zealand Neonatal Network, 1995-97. Arch Dis Child Fetal Neonatal Ed. 2002. 86:F86–F90.

4. Synnes AR, Chien LY, Peliowski A, Baboolal R, Lee SK. Variations in intraventricular hemorrhage incidence rates among Canadian neonatal intensive care units. J Pediatr. 2001. 138:525–531.

5. Osborn DA, Evans N, Kluckow M. Hemodynamic and antecedent risk factors of early and late periventricular/intraventricular hemorrhage in premature infants. Pediatrics. 2003. 112:33–39.

6. Babnik J, Stucin-Gantar I, Kornhauser-Cerar L, Sinkovec J, Wraber B, Derganc M. Intrauterine inflammation and the onset of peri-intraventricular hemorrhage in premature infants. Biol Neonate. 2006. 90:113–121.

7. Vural M, Yilmaz I, Ilikkan B, Erginoz E, Perk Y. Intraventricular hemorrhage in preterm newborns: risk factors and results from a University Hospital in Istanbul, 8 years after. Pediatr Int. 2007. 49:341–344.

8. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weighs less than 1500g. J Pediatr. 1978. 92:529–534.

9. Enzmann D, Murphy-Irwin K, Stevenson D, Ariagno R, Barton J, Sunshine P. The natural history of subependymal germinal matrix hemorrhage. Am J Perinatol. 1985. 2:123–133.

10. Volpe JJ. Intracranial hemorrhage: germinal matrix hemorrhage of the premature infant. Neurology of the Newborn. 2001. Philadelphia: WB Saunders;435–448.

11. Chey MJ, Chang YP, Choi JH, Hwang YS, Yun CK, Kim IO, Yeon KM. A clinical study of periventricular-intraventricular hemorrhage in very low birth weight infants. J Korean Pediatr Soc. 1990. 33:1341–1352.

12. Vergani P, Patane L, Doria P, Borroni C, Cappellini A, Pezzullo JC, Ghidini A. Risk factors for neonatal intraventricular haemorrhage in spontaneous prematurity at 32 weeks gestation or less. Placenta. 2000. 21:402–407.

13. Ertan AK, Tanriverdi HA, Meier M, Schmidt W. Perinatal risk factors for neonatal intracerebral hemorrhage in preterm infants. Eur J Obstet Gynecol Reprod Biol. 2006. 127:29–34.

14. Verma U, Tejani N, Klein S, Reale MR, Beneck D, Figueroa R, Visintainer P. Obstetric antecedants of intraventricular hemorrhage and periventricular leukomalacia in the low-birth-weight neonate. Am J Obstet Gynecol. 1997. 176:275–281.

15. Linder N, Haskin O, Levit O, Klinger G, Prince T, Naor N, Turner P, Karmazyn B, Sirota L. Risk factors for intraventricular hemorrhage in very low birth weight premature infants: a retrospective case-control study. Pediatrics. 2003. 111:e590–e595.

16. Vermeulen GM, Bruinse HW, de Vries LS. Perinatal risk factors for adverse neurodevelopmental outcome after spontaneous preterm birth. Eur J Obstet Gynecol Reprod Biol. 2001. 99:207–212.

17. Mancini MC, Barbosa NE, Banwart D, Silveira S, Guerpelli JL, Leone CR. Intraventricular hemorrhage in very low birth weight infants: associated risk factors and outcome in the neonatal period. Rev Hosp Clin Fac Med Sao Paulo. 1999. 54:151–154.

18. Evans N, Kluckow M. Early ductal shunting and intraventricular haemorrhage in ventilated preterm infants. Arch Dis Child Fetal Neonatal Ed. 1996. 75:F183–F186.

19. Perlman JM, Risser RC, Gee JB. Pregnancy-induced hypertension and reduced intranventricular hemorrhage in preterm infants. Pediatr Neurol. 1997. 17:29–33.

20. Ment LR, Vohr BR, Allan W, Westerveld M, Sparrow SS, Schneider KC, Katz KH, Duncan CC, Makuch RW. Outcome of children in the indomethacin intraventricular hemorrhage prevention trial. Pediatrics. 2000. 105:485–491.

21. Fowlie PW, Davis PG. Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants. Cochrane Database Syst Rev. 2002. CD000174.

22. Schmidt B, Davis P, Moddemann D, Ohlsson A, Roberts RS, Saigal S, Solimano A, Vincer M, Wright LL. Long-term effects of indomethacin prophylaxis in extremely-low-birth-weight infants. N Engl J Med. 2001. 344:1966–1972.

23. Perlman JM, McMenamin JB, Volpe JJ. Fluctuating cerebral blood-flow velocity in respiratory-distress syndrome. Relation to the development of intraventricular hemorrhage. N Engl J Med. 1983. 309:204–209.

24. Bray M, Stucchi I, Fumagalli M, Pugni L, Ramenghi L, Agosti M, Mosca F. Blood withdrawal and infusion via umbilical catheters: effect on cerebral perfusion and influence of ibuprofen. Biol Neonate. 2003. 84:187–193.

25. Perlman JM, Goodman S, Kreusser KL, Volpe JJ. Reduction in intraventricular hemorrhage by elimination of fluctuating cerebral blood-flow velocity in preterm infants with respiratory distress syndrome. N Engl J Med. 1985. 312:1353–1357.

26. Ment LR, Stewart WB, Duncan CC, Lambrecht R. Beagle puppy model of intraventricular hemorrhage. J Neurosurg. 1982. 57:219–223.

27. Short BL, Walker LK, Traystman RJ. Impaired cerebral autoregulation in the newborn lamb during recovery from severe, prolonged hypoxia, combined with carotid artery and jugular vein ligation. Crit Care Med. 1994. 22:1262–1268.

28. Bada HS, Korones SB, Perry EH, Arheart KL, Ray JD, Pourcyrous M, Magill HL, Runyan W 3rd, Somes GW, Clark FC. Mean arterial blood pressure changes in premature infants and those at risk for intraventricular hemorrhgae. J Pediatr. 1990. 117:607–614.

29. Goddard-Finegold J, Armstrong D, Zeller RS. Intraventricular hemorrhage, following volume expansion after hypovolemic hypotension in the newborn beagle. J Pediatr. 1982. 100:796–799.

30. Wells JT, Ment LR. Prevention of intraventricular hemorrhage in preterm infants. Early Hum Dev. 1995. 42:209–233.