Risk factors of intraventricular hemorrhages in premature infants: the results of a single-center study
AbstractIdentification of risk factors for the development of intraventricular hemorrhages (IVH) is an urgent direction and is important in the development of prevention strategies.
The aim: to identify ante-, intra- and postnatal risk factors for the development of IVH of varying severity in premature infants in the early neonatal period based on the analysis of anamnesis data, the results of clinical, laboratory and instrumental tests.
Material and methods. The retrospective case-control study was conducted from 2017 to 2020 in National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Ministry of Health of the Russian Federation. The infants included in the study (100 premature infants with various degrees of IVH) were divided into three groups depending on the severity of IVH: group 1 – premature newborns with IVH grade 1 (n=66); group 2 – premature newborns with IVH grade 2 (n=26); group 3 – premature newborns with IVH grade 3 (n=8).
Results. It was found that the smaller gestational age (GA) and anthropometric data at birth (weight and length) the heavier the degree of IVH (p<0.001) were. The gender of infants, as well as Apgar scores at 1st and 5th minutes did not differ significantly between the groups. All infants of group 3 required invasive respiratory therapy, cardiotonic and vasopressor therapy. In group 2 invasive respiratory therapy was noted in 80.8%, in cardiotonic and vasopressor therapy – in 69.2%. Fluctuations in diastolic blood pressure during 24 hours before IVH had a significant effect on the severity of IVH. According to ROC analysis the threshold value of minimum diastolic pressure (23.5 mm Hg or less, sensitivity 80% and specificity 79%) and heart rate fluctuations during 24 hours before IVH (40 beats per minute or more, sensitivity 80% and specificity 78%) associate with the IVH grade 3 were found.
Conclusion. Low GA, low birth weight and length, the need for invasive respiratory therapy, cardiotonic and vasopressor therapy, low diastolic blood pressure and heart rate fluctuations in the previous 24 hours before IVH are risk factors for the development of IVH in premature infants.
Keywords: preterm infants; intraventricular hemorrhage; clinical risk factors; monitoring; short-term neonatal morbidities
Funding. Within the framework of the state task of R&D No. 121031900157-6 “Predictors and dynamics of neurological disorders in very premature children with extremely low and very low birth weight”.
Conflict of interest. The authors declare no conflict of interest.
For citation: Kirtbaya A.R., Ionov O.V., Balashova E.N., Sharafutdinova D.R., Golubtsova Yu.M., Suvorova D.Yu., Suvorov I.A., Ushakova L.V., Bykova Yu.K., Filippova E.A., Zubkov V.V. Risk factors of intraventricular hemorrhages in premature infants: the results of a single-center study. Neonatologiya: novosti, mneniya, obuchenie [Neonatology: News, Opinions, Training]. 2024; 12 (2): 8–19. DOI: https://doi.org/10.33029/2308-2402-2024-12-2-8-19 (in Russian)
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