Risk Factors for Intraventricular Hemorrhage in Very Low Birth Weight Premature Infants: A Retrospective Case-Control Study

Linder, Nehama; Haskin, Orli; Levit, Orli; Klinger, G; Prince, Tal; Naor, N.; Turner, Paul J.; Karmazyn, Boaz; Sirota, Lea

doi:10.1542/peds.111.5.e590

Cited by 250 publications

(179 citation statements)

References 31 publications

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“…Increased serum levels of interleukin 6 were associated with severe IVH in extremely preterm infants. Regarding to infection, similar to what was described by other authors, in this study neonatal sepsis was associated with a larger number of IVH when compared to controls, but this association lacked statistical significance in the multivariate analysis [30][31][32].…”

Section: Discussionsupporting

confidence: 87%

Low-grade intraventricular hemorrhage and neurodevelopment at 24 months of age

Peixoto

Amaral

Resende

et al. 2018

Sci Med

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AIMS: To evaluate the impact of low-grade intraventricular hemorrhage on neurodevelopmental outcome in preterm infants at 24 months of age. METHODS: We conducted a retrospective case-control study of infants with gestational age less than 34 weeks, admitted to a Neonatal Intensive Care Unit between January/2006 and December/2015. Cases were defined as those with low-grade intraventricular hemorrhage (grades I or II), diagnosed by cranial ultrasonography. For each case, a control with the same gestational age but without intraventricular hemorrhage was selected. Follow-up examinations of neurodevelopment were performed at 24 months of age in cases and controls using the Griffiths Mental Development Scale. Cerebral palsy, neurodevelopmental delay (developmental quotient <2 side deviations below the mean), hearing impairment and/or blindness were considered as severe neurodevelopmental impairment. RESULTS: The study included 172 preterm infants: 86 cases and 86 controls. In the univariate analysis, a difference between the two groups was identified for the following clinical findings: antenatal corticosteroid complete cycle (57% in cases vs. 80% in controls; p=0.001; OR: 0.33, 95%CI 0.17-0.64); male gender (63% cases vs. 41% controls; p=0.004; OR: 2.45, 95%CI 1.3-4.5); outborn (26% cases vs. 9% controls; p=0.005; OR: 3.3 95%CI 1.4-8.0); Clinical Risk Index for Babies higher than 5 (24% in cases vs. 12% in controls; p=0.029; OR: 2.4 95%CI 1.1-5.6); intubation in the delivery room (47% cases vs. 27% controls; p=0.007; OR: 2.38 95%CI 1.3-4.5); and neonatal sepsis (34% in cases vs. 20% in controls; p=0.039; OR: 2.1 95%CI 1.03-4.1). After logistic regression, differences were only maintained for antenatal corticosteroid (p=0.005; OR 0.34, 95%CI 0.16-0.72) and male gender (p=0.002; OR 2.9, 95%CI 1.4-5.8). A severe neurodevelopmental deficit was present in three cases (3.5%) and one control (1.2%). No statistically significant differences in outcome were found between cases and controls. CONCLUSIONS: In this sample, preterm infants with low-grade intraventricular hemorrhage diagnosed by cranial ultrasonography had no difference in early neurodevelopmental outcome when compared with controls.KEYWORDS: cerebral intraventricular hemorrhage; preterm infant; neurodevelopmental disorders. RESUMOOBJETIVOS: Avaliar o impacto da hemorragia intraventricular de baixo grau no neurodesenvolvimento de lactentes prematuros aos 24 meses de idade. MÉTODOS: Foi conduzido um estudo de caso-controle retrospectivo em lactentes com idade gestacional inferior a 34 semanas, internados em uma Unidade de Terapia Intensiva Neonatal entre janeiro de 2006 e dezembro de 2015. Os casos foram definidos como aqueles com hemorragia intraventricular de baixo grau (graus I ou II), diagnosticada por ultrassonografia craniana. Para cada caso, foi selecionado um controle com a mesma idade gestacional, mas sem hemorragia intraventricular. A avaliação do neurodesenvolvimento foi realizada aos 24 meses de idade, em casos e controles, com a Escala de Desen...

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Section: Discussionsupporting

confidence: 87%

Low-grade intraventricular hemorrhage and neurodevelopment at 24 months of age

Peixoto

Amaral

Resende

et al. 2018

Sci Med

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“…The first study failing to find a relationship included premature infants born from 1981 to 1984; 25 the subsequent two published studies involved premature infants born during the surfactant era. 26,27 In glaring contrast to previous studies, hypocapnia, not hypercapnia, was observed by Erickson et al 26 to be an important risk factor for severe IVH or periventricular leukomalacia in ventilated premature infants born from 1992 to 1994. In the third study, hypocapnia during the first day of life was actually found to be protective against IVH.…”

Section: Discussionmentioning

confidence: 79%

“…In the third study, hypocapnia during the first day of life was actually found to be protective against IVH. 27 Inconsistency in results between studies is likely due to the inclusion of infants of different gestational ages and birth weights, various proportions of outborn infants, different sample sizes, and changing goals for ventilation. Disparate criteria for IVH and different PaCO 2 cutoffs were often used, as well as many of the studies only used univariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Hypercapnia during the first 3 days of life is associated with severe intraventricular hemorrhage in very low birth weight infants

et al. 2006

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Objective: To examine whether hypercapnia in very low birth weight (VLBW) infants during the first 3 days of life is associated with severe intraventricular hemorrhage (IVH).Study design: Retrospective cohort study of inborn VLBW infants between January 1999 and May 2004 with arterial access during the first 3 days of life. A multiple logistic regression analysis was used where IVH was dichotomized ((grades 0/1/2) ¼ non-severe; (grades 3/4) ¼ severe). Measures of hypercapnia were entered into the model to ascertain their association with severe IVH.Results: In total, 574 VLBW infants met entry criteria. Worst IVH grade was 0 in 400; 1: 54; 2: 42; 3: 47; and 4: 31 infants. The logistic regression model consisted of the following predictors of severe IVH: gestational age, gender, 1 min Apgar score (dichotomized into two groups: >3 vs p3), multifetal gestation, vasopressor use, and maximum PaCO 2 .Conclusion: In addition to traditional risk factors, it appears maximum PaCO 2 is a dose-dependent predictor of severe IVH during the permissive hypercapnia era.

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“…Inaccurate ETT placement may increase the infant's risk for pneumothorax and subsequent intraventricular hemorrhage. 12,13 Secondly, surfactant is often given prophylactically in the delivery room prior to radiographic confirmation of the ETT position. If the ETT is positioned too deep, right mainstem bronchus intubation may occur and surfactant may be preferentially given to the right lung.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of the 7-8-9 Rule for endotracheal tube placement in the neonate

Johnson

Deakins

et al. 2006

J Perinatol

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Objective: To determine accuracy of the 7-8-9 Rule in a cohort of neonates.Study Design: This study was cross-sectional in design. Seventy-five consecutive neonates who required oral intubation from June 2004 to November 2004 for cardiopulmonary failure, respiratory distress, or surfactant administration were the subjects of this study. The initial endotracheal tube (ETT) depth of insertion was determined using either an estimated birth weight or actual weight in the 7-8-9 Rule calculation followed by auscultation and subsequent adjustment if necessary. Midtracheal position was identified as the point halfway between the inferior clavicle and carina on a chest radiograph. The initial depth was compared to the midtracheal depth to determine clinical accuracy of the 7-8-9 Rule. The depth predicted by the 7-8-9 Rule was also calculated using only actual weights. This predicted depth was compared to the midtracheal depth to determine true accuracy of the 7-8-9 Rule. Accuracy was determined using mean paired differences with 95% confidence intervals (CI) between initial or predicted depth and ideal, midtracheal ETT depth. Linear regression was used to adjust for confounding variables.Results: Mean (range) gestational age was 32 weeks (23 to 44 weeks) and weight was 2001 g (490 to 4400 g). Eighteen (24%) infants weighed 1000 g or less, 20 (27%) weighed between 1001 and 2000 g, 21 (28%) weighed between 2001 and 3000 g, 15 (20%) weighed between 3001 and 4000 g, and one (1%) weighed more than 4000 g. Thirteen of the 18 extremely low birth weight infants weighed <750 g. The initial depth of insertion was 0.004 cm above midtracheal position (95% CI À0.13 to 0.14, P ¼ 0.96). After controlling for head position, the initial depth did not significantly differ from the midtracheal position among weight groups. Predicted depth using the 7-8-9 Rule placed the ETT 0.12 cm above midtracheal position (95% CI À0.30 to 0.06, P ¼ 0.20). However, after controlling for head position, the 7-8-9 Rule positioned the ETT significantly below midtracheal position in infants weighing <750 g (mean 0.62 cm; 95% CI 0.30 to 0.93, P ¼ 0.002). Conclusions:The 7-8-9 Rule appears to be an accurate clinical method for endotracheal tube placement in neonates weighing more than 750 g. When the 7-8-9 Rule is applied to infants weighing <750 g, caution is warranted. The current rule may lead to an overestimated depth of insertion and potentially result in clinically significant consequences.

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Risk Factors for Intraventricular Hemorrhage in Very Low Birth Weight Premature Infants: A Retrospective Case-Control Study

Cited by 250 publications

References 31 publications

Low-grade intraventricular hemorrhage and neurodevelopment at 24 months of age

Low-grade intraventricular hemorrhage and neurodevelopment at 24 months of age

Hypercapnia during the first 3 days of life is associated with severe intraventricular hemorrhage in very low birth weight infants

Accuracy of the 7-8-9 Rule for endotracheal tube placement in the neonate

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