A systematic review and meta-analysis of the timing of early intraventricular hemorrhage in preterm neonates: Clinical and research implications

Abstract

A considerable number of intraventricular hemorrhages (IVH) occur within the first hours of life (HOL). Temporality between IVH and its antecedents as well as a consistent definition of “early IVH” is lacking in a large and growing body of literature. We performed a systematic review of prospective studies that reported onset of IVH in preterm neonates within the first HOL and afterwards. The English literature was searched using three databases up to March 2013. Four timing periods of IVH can be compared in 16 identified studies: 0-6; 7-12; 13-24; after 24 HOL. The 0-6 and after 24 HOL were the major modes of IVH timing. Pooled IVH proportions were estimated through a meta-analysis of studies that were conducted after antenatal steroid and surfactant era. In neonates weighing ≤1500 g at birth: 48% of IVH (95% CI: 42-58%, 5 studies, 279 IVH cases) occurred during 0-6 HOL and 38% (95% CI: 19-57%, 4 studies, 241 IVH cases) after 24 HOL. The 0-6 HOL is the shortest, most vulnerable period for IVH, thus, an early IVH is an IVH occurs in it. Such early IVH had prognostic, etiological/preventive and medicolegal implications. Accordingly, preterm neonates at risk of IVH should have their first routine screening head ultrasound at about 6 HOL. Future research exploring the antecedents of IVH should guaranty the temporality between these antecedents and IVH. Additional research will be required to determine whether the long term neurological outcomes of early and late IVH are the same.

Low-Grade Intraventricular Hemorrhage and Neurodevelopmental Outcomes at 24-42 Months of Age

“…Some studies suggest that early-onset intraventricular hemorrhage (within the first 6 hours) may result in worse neurodevelopmental outcomes. 24 Although 90% of intraventricular hemorrhage can be detected by the end of the first postnatal week, the effect of a new bleed later during the neonatal intensive care unit stay is unclear. 25 Studies in adults suggest that the location of an intraventricular hemorrhage may influence outcomes in patients with severe hemorrhage, but there are no such studies assessing low-grade intraventricular hemorrhage.…”

Time-to-event analysis of surgically treated posthemorrhagic hydrocephalus in preterm infants: a single-institution retrospective study

“…A 2014 meta-analysis by Al-Abdi and Al-Aamri incorporated 5 prospective studies and found two major modes of IVH timing in 279 cases—0–6 hours (48% of cases) and after 24 hours of life (38%) [2, 4, 8, 10, 17, 18]. Although our retrospective review was unable to provide more resolution within the first day of life due to the hours when routine HUS were available, we showed that the majority of IVH occurs within the first 2 days, a finding that is consistent with previous studies [38].…”

“…While a number of studies have examined the timing of IVH development in preterm neonates [2, 4, 8–10, 17–19, 23, 33, 38], the few that have focused on the time-course of PHH included only a small number of subjects who developed the condition [13, 21, 25, 37]. Understanding the temporal profile of this disease may elucidate the optimal diagnosis and treatment timeframe and help improve clinical management.…”

Prenatal and postnatal inflammation-related risk factors for retinopathy of prematurity

“…In most cases, IVH occurs in the first week of life, prior to ROP development. 36 NEC was diagnosed at surgery, at postmortem examination or clinically and radiographically using the following criteria: at least one of the following clinical signs present: 1) bilious gastric aspirate or emesis, 2) abdominal distension, 3) occult or gross blood in stool (no fissure) AND at least one of the following radiographic findings present: 1) pneumatosis intestinalis, 2) hepato-biliary gas, 3) pneumoperitoneum. This definition for NEC also requires that infants with spontaneous intestinal perforation confirmed at laparotomy or post-mortem examination be excluded.…”