Intraventricular hemorrhage prediction in premature neonates in the era of hemodynamics monitoring:a prospective cohort study

Abstract

Purpose Unstable hemodynamics and prematurity are the main players in IVH development. Our objective was the use of SVCF, LVO and RVO, and ACA Doppler measures in prediction of IVH in the first week of life in preterm infant ≤ 32 weeks.Method Prospective cohort Study in NICU of the Maternity university hospital is presented. Of 147 patients, 132 infants born ≤32 weeks GA were enrolled in the study. 127 completed the study till 7th day of life. Infants were scanned for ACA-RI using transfontanellar ultrasound, and SVC flow, LVO, and RVO using FE in the first 24 hours after birth. Patients had another two scans on DOL3 and7 to detect IVH development. Results Low SVCF and high ACA-RI significantly increased the risk of IVH using logistic regression models with (OR, 3.16; 95%Cl, 1.19 – 8.39; P0.02) and (OR, 1.64; 95%Cl, 1.10 – 2.44;P0.02),respectively. Low SVCF and high ACA-RI significantly increased risk of catastrophic IVH P 0.025 and 0.023, respectively. Combined use Low SVCF < 55 ml/kg/min and ACA-RI > 0.75 is predictor of IVH with sensitivity 40.8% and 82.1% specificity. This work was registered in clinical trial.gv no NCT05050032ConclusionsThere are strong relations between both low SVC flow and high ACA-RI and IVH development in premature neonates ≤32 weeks, with more significance towards catastrophic IVH. Admission RSS and LVO are the strongest factors affecting SVC flow. PDA size (mm/kg) and CRT were significantly associated with high ACA-RI. Theses finding helps in more understanding of pathophysiological factors affecting central perfusion that might affect the longer term neurodeveopmental outcome.