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

Mi-Kyung Cheon; Sook-Kyung Yum; Cheong-Jun Moon; Young-Ah Youn; So-Young Kim; In-Kyung Sung

doi:10.14734/kjp.2014.25.4.266

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Cheon, Yum, Moon, Youn, Kim, and Sung: Risk Factors for Severity of Intraventricular Hemorrhage in Very Low Birth Weight Infants and Neurodevelopmental Outcomes

Original Article

Korean J Perinatol 2014;25(4):266-275.

Published online: 21 December 2014

DOI: https://doi.org/10.14734/kjp.2014.25.4.266

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

Mi-Kyung Cheon, M.D., Sook-Kyung Yum, M.D., Cheong-Jun Moon, M.D., Young-Ah Youn, M.D., So-Young Kim, M.D., In-Kyung Sung, M.D.

Department of Pediatrics, Seoul St. Mary’s Hospital, Catholic University, Seoul, Korea

Received 7 August 201416 September 2014 Accepted 16 October 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 bronchopulmonary 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.

Keywords: Intraventricular hemorrhage, Prematurity, Risk factors, Outcome

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Table 1.

Clinical characteristics of 145 very low birth weight infants with intraventricular hemorrhage

	IVH		P
	Grade I+II (n=87)	Grade III+IV (n=58)	P
Gestational age (weeks)	28.0±2.4	26.4±2.2	0.000
Birth weight (g)	1,115±223	966±233	0.000
SGA	18 (20.7)	10(17.2)	0.509
Male sex	43 (49.4)	32(55.2)	0.611
C-sec delivery	71 (81.6)	43(74.1)	0.366
Twin	31 (27.7)	25(43.1)	0.388
Outborn	18 (20.7)	6 (10.3)	0.855

Data expressed as mean±SD or number of cases (%)

Abbreviations: IVH, intraventricular hemorrhage, SGA, small-for-gestational age; C-sec, Cesarean section; Outborn, birth at an outside hospital

Table 2.

Obstetric factors for intraventricular hemorrhage in very low birth weight infants

	IVH		P
	Grade I+II (n=87)	Grade III+IV (n=58)	P
Maternal age (years)	33.1±4.5	32.1±3.4	0.168
PIH	17 (19.5)	5 (8.6)	0.073
GDM	7 (8.0)	2 (3.4)	0.261
Antenatal steroid	26 (30.0)	10 (17.2)	0.184
Chorioamnionitis	17 (19.5)	9 (15.5)	0.536
Maternal U. urealyticum	39 (44.8)	20 (34.5)	0.232
PROM	25 (28.7)	15 (25.9)	0.704
PROM (hours)	47.4±154.3	22.2±50.3	0.233
Fetal distress	16 (18.4)	5 (8.6)	0.148

Data expressed as mean±SD or number of cases (%)

Abbreviations: IVH, intraventricular hemorrhage; PIH, Pregnancy-induced hypertension; GDM, Gestational diabetes mellitus; U. urealyticum, Ureaplasmaurealyticum; PROM, Premature rupture of membrane

Table 3.

Postnatal factors for intraventricular hemorrhage in very low birth weight infants

	IVH		P
	Grade I+II (n=87)	Grade III+IV (n=58)	P
Apgar score, 1 min.	3.4±1.8	2.6±1.8	0.008
5 min	5.7±1.9	4.7±2.1	0.005
Hypotension or shock	49 (56.3)	52 (89.7)	0.000
ABGA, PaCO₂, maximum (mmHg)	71.1±24.1	91.6±27.5	0.000
ABGA, PaCO₂, minimum (mmHg)	32.6±5.9	34.2±6.5	0.141
ABGA (pH)	7.2±0.1	7.0±0.4	0.314
PDA	49 (56.3)	49 (84.5)	0.000
PDA, maximum (mm)	1.24±1.28	2.24±1.26	0.045
RDS (≥grade 3)	57 (65.5)	33 (56.9)	0.362
Pneumothorax	1 (1.1)	6 (10.3)	0.011
MV duration (days)	22.6±26.9	32.2±4.2	0.001
Oxygen duration (days)	65.1±56.9	75.6±53.9	0.020
Neutropenia	11 (12.6)	12 (20.7)	0.247
Thrombocytopenia	51 (58.6)	47 (81.0)	0.005
Apneic spell	54 (62.0)	45 (77.6)	0.049
NEC	3 (3.4)	9 (15.5)	0.000
BPD (≥moderate)	26 (29.9)	27 (46.6)	0.022
ROP with laser coagulation	25 (28.7)	19 (32.8)	0.279
Pneumonia	11 (12.6)	6 (10.3)	0.673

Data expressed as mean±SD or number of cases (%)

Abbreviations: IVH, intraventricular hemorrhage; ABGA, arterial blood gas analysis; PDA, patent ductusarteriosus; RDS, respiratory distress syndrome; MV, Mechanical ventilation; NEC, necrotizing enterocolitis; BPD, bronchopulmonary dysplasia; ROP, retinopathy of prematurity

Table 4.

Logistic regression analysis of factors for intraventricular hemorrhage in very low birth weight infants

	Odds ratio	95% confidence interval
Gestational age (weeks)	0.966	0.925-0.997
Birth weight (g)	0.997	0.995-0.999
Apgar score, 1 min.	0.864	0.524-1.425
5 min	1.274	0.809-2.005
Hypotension or shock	8.581	1.410-52.206
ABGA, PaCO₂, maximum (mmHg)	0.990	0.968-1.012
PDA	1.335	0.330-5.400
Pneumothorax	3.828	0.282-51.928
MV duration (days)	1.027	1.002-1.053
Oxygen duration (days)	1.034	1.012-1.057
Thrombocytopenia	0.710	0.224-2.252
Apneic spell	0.905	0.272-3.010
NEC	2.696	0.851-8.541
BPD (≥moderate)	2.354	0.715-4.089

Abbreviations: ABGA, arterial blood gas analysis; PDA, patent ductusarteriosus; MV, Mechanical ventilation; NEC, necrotizing enterocolitis; BPD, bronchopulmonary dysplasia

Table 5.

Multiple logistic regression analysis of factors for intraventricular hemorrhage in very low birth weight infants

	Odds ratio	95% confidence interval
Gestational age (weeks)	0.972	0.932-0.998
Birth weight (g)	0.997	0.995-0.999
Hypotension or shock	6.482	2.165-19.407

Table 6.

The neurodevelopmental outcomes in 108 very low birth weight infants

	IVH		P
	Grade I+II (n=87)	Grade III+IV (n=32)	P
Major ND impairment	8 (9.2)	15 (46.9)	0.002
Cognitive impairment	1 (1.1)	3 (9.4)	0.204
Cerebral palsy	7 (8.0)	12 (37.5)	0.013
Visual deficit	0 (0.0)	3 (9.4)	0.012
Hearing deficit	2 (2.3)	3 (9.4)	0.402
Epilepsy	0 (0.0)	2 (6.3)	0.060

Data expressed number of cases (%)

Abbreviations: IVH, intraventricular hemorrhage; ND, neurodevelopmental

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