Intraventricular hemorrhage in preterm infants: risk factors and neurodevelopmental outcomes

Abstract

Introduction: Germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) is the most common form of intracranial hemorrhage in preterm infants. We evaluated risk factors for GMH-IVH in preterm infants born before 32 weeks of gestational age. Secondary outcomes included the characterization of neurodevelopmental (ND) prognosis at 24-36 months of corrected age.

Methods: We included infants admitted to our Neonatal Intensive Care Unit between May 2011 and January 2017. A total of 161 infants were enrolled, divided into the GMH-IVH group (n = 40) and control group (n = 121). A secondary cohort included the follow-up group (n = 124) at 24-36 months of corrected age. The association of GMH-IVH with risk factors and ND outcomes was investigated.

Results: The incidence of GMH-IVH was 24.8%. Significant risk factors for GMH-IVH were exposure to any resuscitation in the Delivery Room (adjusted odds ratio [aOR]: 34.1; 95% confidence interval [CI] 1.8-657.5) and a low Apgar score at 5 minutes of life (aOR: 0.4; 95% CI: 0.2-0.9). The incidence of retinopathy of prematurity was significantly higher in the grade I GMH-IVH (p < 0.001) group. Gross motor and locomotion dysfunction were significantly more frequent in the GMH-IVH group (24.1% vs. 4.4%; p = 0.004) as was auditory and language dysfunction (24.1% vs. 7.8%; p = 0.040). GMH-IVH was independently associated with visual impairment (aOR: 21.6; 95% CI: 3.2-145.0). 

Conclusions: Lower Apgar score at 5 minutes of life and any resuscitation were independent risk factors for GMH-IVH. GMH-IVH was associated with higher ND morbidity. ND prognosis of grade II GMH-IVH was comparable to grade III GMH-IVH.