Risk factors for intraventricular hemorrhage in premature infants in the central region of Saudi Arabia

Abstract

Background Intraventricular hemorrhage (IVH) is a serious complication of premature (<32 weeks) deliveries, especially in very-low-birth-weight (VLBW; <1500 g) neonates. Infants developing severe IVH are more prone to long-term developmental disabilities. Although 62%–79% of women in Saudi Arabia receive antenatal steroids, IVH incidence remains high. We analyzed the risk factors for IVH in preterm VLBW neonates in the central region of Saudi Arabia. Methods We included premature infants with IVH (n = 108) and gestational age- and birth weight-matched control group infants (n = 108) admitted to our neonatal intensive care unit. Cases were divided into mild (grades I and II; n = 56) and severe (grades III and IV; n = 52) IVH groups. Association of IVH with risk factors in the first week of life was investigated. Results The following risk factors were associated with severe IVH: lack of antenatal steroid administration ( P < .001), pulmonary hemorrhage ( P = .023), inotrope use ( P = .032), neonatal hydrocortisone administration ( P = .001), and patent ductus arteriosus (PDA) ( P = .005). Multivariable logistic regression analysis revealed the following to be significant: lack of antenatal dexamethasone (adjusted odds ratio [aOR]: 0.219, 95% confidence interval [95% CI] 0.087–0.546), neonatal hydrocortisone administration (aOR: 3.519, 95% CI 1.204–10.281), and PDA (aOR: 2.718, 95% CI 1.024–7.210). Low hematocrit in the first 3 days of life was significantly associated with severe IVH (all P < .01). Conclusions Failure to receive antenatal dexamethasone, PDA, hydrocortisone administration for neonatal hypotension, and low hematocrit in the first 3 days of life was associated with severe IVH in VLBW neonates. Clinicians and healthcare policy makers should consider these factors during decision-making.

Antenatal care of mothers and morbidity and mortality disparities among preterm Saudi and non-Saudi infants less than or equal to 32 weeks' gestation

“…Regarding intraventricular hemorrhage, we assessed risk factors for IVH in premature infants who were less than 32 weeks' gestation and found that antenatal steroids are among the most common factors that reduce the incidence of severe IVH. 19 However, we did not examine whether the outcome would be affected by whether the patients were Saudi or not. In this study, we found that premature Saudi infants developed IVH less frequently than non-Saudis.…”

Predictive Risk Factors for Mild and Severe Germinal Matrix Hemorrhage and Associated Neurodevelopmental Prognosis: A Retrospective Study

“…This was also shown in previous studies as they stated that a low hematocrit was associated with severe GMH-IVH in preterm neonates. Moreover, a higher initial hematocrit decreased the incidence of premature GMH-IVH [20,3]. However, it is unclear whether a low hematocrit is considered a risk factor of GMH-IVH or it is low due to bleeding [3].…”

“…Moreover, a higher initial hematocrit decreased the incidence of premature GMH-IVH [20,3]. However, it is unclear whether a low hematocrit is considered a risk factor of GMH-IVH or it is low due to bleeding [3].…”

“…Among preterm infants born in Saudi Arabia, the incidence of GMH-IVH is between 13% to 27%. Hence, it is valuable to detect and control the factors that might contribute to its development [3].…”

“…It is established that GMH-IVH is strongly associated with a broad spectrum of neurological consequences such as hydrocephalus, cerebral palsy, seizures, cognitive or learning disabilities. Preterm infants with severe GMH-IVH (grade III & IV) are more prone to neurological consequences [3].…”