Factors Associated with Early Severe Intraventricular Haemorrhage in Very Low Birth Weight Infants

Abstract

Objective: The aim of this study was to identify factors associated with early IVH grades III–IV in the first 72 h of life in very low birth weight (VLBW) preterm infants.

Methods: A case-control study was performed in 28 preterm infants and 55 controls. The mean of all blood gas determinations, presence of arterial hypotension, variables related to mechanical ventilation, as well as antenatal and neonatal comorbidities during the first 3 days of life were evaluated.

Results: The proportion of infants with pH<7.2, PaCO₂ >55 mmHg and arterial hypotension was higher in the case group. PaCO₂ >55 mmHg was more frequently found in patients with IVH grades III (16.6 vs. 1.8%; p=0.03) and IV (37.5 vs. 1.8%; p=0.0001) than in controls, respectively. Gestational age (β=−0.30; p=0.04), BE (β=0.33; p=0.0005) and arterial hypotension (β=0.40; p=0.00003) were associated to both grades of IVH (R²=0.39; p<0.0001 for the model). However, only birth weight and arterial hypotension were identified as factors related to IVH grade III (R²=0.44; p=0.0001 for the model) and PaCO₂ >55 mmHg, and BE as factors for IVH grade IV (R²=0.32; p=0.0003 for the model).

Conclusion: Birth weight and arterial hypotension were factors related to early IVH grade III, whereas hypercapnia and large BE were factors related to IVH grade IV in VLBW infants.

Key words

intraventricular haemorrhage - preterm infants - hypercapnia - sepsis - base excess

References

• 1 Altman DG. Relation between several variables.. In: Altman DG Practical statistics for medical research. Chapman and Hall Ed. New York; 1991: 351-358
• 2 Ambalavanan N, Carlo WA. Hypocapnia e hypercapnia respiratory management of newborn infants.  Clin Perinatol. 2001;  28 517-531
• 3 Bassan H, Gauvreau K, Newburger JW. et al . Identification of pressure passive cerebral perfusion and its mediators after infant cardiac surgery.  Pediatr Res. 2005;  57 35-41
• 4 Bassan H, Feldman HA, Limperopoulos C. et al . Periventricular hemorrhagic infarction: risk factors and neonatal outcome.  Pediatr Neurol. 2006;  35 85-92
• 5 Cortez JC, Chawla S, Kazzi SN. Cumulative hypercapnia and risk of intraventricular hemorrhage among very low birth weight infants.  Pediatr Res. 2006;  60 491
• 6 Donovan EJ, Hall MA. Management of periventricular haemorrhage and its sequelae.  Current Paediatrics. 1999;  9 108-112
• 7 Durand DJ, Philips B, Boloker JD. Gases sanguineos aspectos tecnicos, e interpretación [Blood gases, technical aspects and interpretation].. In: Goldsmith PJ, Karotkin HE Ventilación Asistida Neonatal. 4thEdicion Bogota. 2005. Editora Guadalupe Ltda, p 411-429
• 8 Edwards AD, Wyatt JS, Richardson C. et al . Effects of indomethacin on cerebral haemodynamics in very preterm infants.  Lancet. 1990;  335 1491-1495
• 9 Erikson SJ, Grauaug A, Gurrin L. et al . Hypocarbia in the ventilated preterm infant and its effect on intraventricular hemorrhage and broncopulmonary dysplasia.  J Paediatr Child Health. 2002;  38 560-562
• 10 Fabres J, Carlo W, Phillips V. et al . Both extremes of arterial carbon dioxide pressure and the magnitude of fluctuations in arterial carbon dioxide pressure are associated with severe intraventricular hemorrhage in preterm infants.  Pediatrics. 2007;  119 299-305
• 11 Guyton AC, Hall JE. Regulación del equilibrio acido base [Regulation of the acid-base equilibrium].. 10th edition, Mexico 2001. Mc Graw Hill, p.; 420-441
• 12 Kaiser JR, Gauss CH, Pont MM. et al . Hypercapnia during the first 3 days of life is associated with severe intraventricular hemorrhage in very low birth weight infants.  J Perinatol. 2006;  26 279-285
• 13 Kluckow M, Evans N. Low superior vena cava flow and intraventricular haemorrhage in preterm infants.  Arch Dis Child Fetal Neonatal Ed.. 2000;  82 F188-F194
• 14 Levene MI, Fawer CL, Lamon RF. Risk factors in the development of intraventricular hemorrhage in the preterm neonate.  Arch Dis Child. 1982;  57 410-417
• 15 Levene MI, Vries L. Extension of neonatal intraventricular haemorrhage.  Arch Dis Child. 1984;  59 631-636
• 16 Mariani G, Cifuentes J, Carlo W. Randomized Trial of permissive hypercapnia in preterm infants.  Pediatrics. 1999;  104 1-13
• 17 Miller JD, Carlo W. Permissive hypercapnia in neonates.  Neo Reviews. 2007;  8 e345
• 18 Papile LA, Burstein J, Burstein R. et al . Incidence and evolution of subependhymal and intraventricular hemorrhage: a study of infants with birth weight less than 1 500 g.  J Pediatr. 1978;  92 529-534
• 19 Pellicer A, Valverde E, Elorza M. et al . Cardiovascular support for low birth weight infants and cerebral hemodynamics: A randomized blinded clinical trial.  Pediatrics. 2005;  115 1501-1511
• 20 Perlman JM, Rollins N. Surveillance protocol for the detection of intracranial abnormalities in premature neonates.  Arch Pediatr Adolesc Med. 2000;  154 822-826
• 21 Rennie JM. Vascular lesions II: lesion typical of inmature infants.. In Neonatal Cerebral Ultrasound. Cambridge University Press; 1997: 123-151
• 22 Sarkar S, Bhagat I, Dechert R. et al . Severe intraventricular hemorrhage in preterm infants: comparison of risk factors and short-term neonatal morbidities between grade 3 and grade 4 intraventricular hemorrhage.  Am J Perinatol. 2009;  26 419-424
• 23 Scorrer T, Drayton M. Preventing periventricular haemorrhage.  Current Paediatrics. 2001;  11 187-191
• 24 Skouteli H, Kuban KC, Leviton A. Arterial blood gas derangements associated with death and intracranial hemorrhage in premature babies.  J Perinatol. 1988;  8 336-341
• 25 Soul JS, Hammer PE, Tsuji M. et al . Fluctuating Pressure-passivity is common in the cerebral circulation of sick premature infants.  Pediatr Res. 2007;  61 467-473
• 26 Volpe JJ. Brain injury in the premature infant: Overview of clinical aspects, neuropathology, and pathogenesis.  Semin Pediatr Neurol. 1998;  5 135-151
• 27 Volpe JJ. Neurology of the newborn, 4th ed.. Philadelphia: W.B. Saunders; 2001: 428-493
• 28 Vural M, Yilmas I, IlikkanB. et al . Intraventricular hemorrhage in preterm newborns.  Pediatrics International. 2007;  49 341-344
• 29 Wallin LA, Rosenfeld CR, Laptook AR. Neonatal intracranial hemorrhage II. Risk factor analysis an in born population.  Early Hum Dev. 1990;  23 129-137
• 30 Watkins AM, West CR, Cooke RW. Blood pressure and cerebral hemorrhage and ischaemia in very low birthweight infants.  Early Hum Dev. 1989;  19 103-110

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