Early Vital Sign Differences in Very Low Birth Weight Infants with Severe Intraventricular HemorrhageFunding This study was supported by grants from National Institutes of Health (NIH)/National Institute of Neurological Disorders and Stroke (NINDS; grant no.: K23 NS111086; Vesoulis) and NIH/NICHD (grant no.: R01 HD072071; Fairchild), as well as by the University of Virginia Brain Institute.
Objective Severe intraventricular hemorrhage (sIVH, grades 3 and 4) is a serious complication for very low birth weight (VLBW) infants and is often clinically silent requiring screening cranial ultrasound (cUS) for detection. Abnormal vital sign (VS) patterns might serve as biomarkers to identify risk or occurrence of sIVH.
Study Design This retrospective study was conducted in VLBW infants admitted to two level-IV neonatal intensive care units (NICUs) between January 2009 and December 2018. Inclusion criteria were: birth weight <1.5 kg and gestational age (GA) <32 weeks, at least 12 hours of systemic oxygen saturation from pulse oximetry (SpO2) data over the first 24 hours and cUS imaging. Infants were categorized as early sIVH (sIVH identified in the first 48 hours), late sIVH (sIVH identified after 48 hours and normal imaging in the first 48 hours), and no IVH. Infants with grades 1 and 2 or unknown timing IVH were excluded. Mean heart rate (HR), SpO2, mean arterial blood pressure (MABP), number of episodes of bradycardia (HR < 100 bpm), and desaturation (SpO2 < 80%) were compared.
Results A total of 639 infants (mean: 27 weeks' gestation) were included (567 no IVH, 34 early sIVH, and 37 late sIVH). In the first 48 hours, those with sIVH had significantly higher HR compared with those with no IVH. Infants with sIVH also had lower mean SpO2 and MABP and more desaturations <80%. No significant differences in VS patterns were identified in early versus late sIVH. Logistic regression identified higher HR and greater number of desaturations <80% as independently associated with sIVH.
Conclusion VLBW infants who develop sIVH demonstrate VS differences with significantly lower SpO2 and higher mean HR over the first 48 hours after birth compared with VLBW infants with no IVH. Abnormalities in early VS patterns may be a useful biomarker for sIVH. Whether VS abnormalities predict or simply reflect sIVH remains to be determined.
A higher HR in the first 48 hours is seen in infants with severe IVH.
Infants with sIVH have lower blood pressure in the first 48 hours.
Infants with sIVH have more oxygen desaturations in the first 48 hours.
Keywordspreterm infant - intraventricular hemorrhage - vital signs - very low birth weight - biomarker
Eingereicht: 13. Oktober 2020
Angenommen: 30. Juni 2021
27. August 2021 (online)
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- 1 Shah NA, Wusthoff CJ. Intracranial hemorrhage in the neonate. Neonatal Netw 2016; 35 (02) 67-71
- 2 Leijser LM, de Vries LS. Preterm brain injury: germinal matrix-intraventricular hemorrhage and post-hemorrhagic ventricular dilatation. Handb Clin Neurol 2019; 162: 173-199
- 3 Ballabh P. Pathogenesis and prevention of intraventricular hemorrhage. Clin Perinatol 2014; 41 (01) 47-67
- 4 Tortora D, Severino M, Malova M. et al. Differences in subependymal vein anatomy may predispose preterm infants to GMH-IVH. Arch Dis Child Fetal Neonatal Ed 2018; 103 (01) F59-F65
- 5 Allan WC, Volpe JJ. Periventricular-intraventricular hemorrhage. Pediatr Clin North Am 1986; 33 (01) 47-63
- 6 Shipley L, Gyorkos T, Dorling J, Tata LJ, Szatkowski L, Sharkey D. Risk of severe intraventricular hemorrhage in the first week of life in preterm infants transported before 72 hours of age. Pediatr Crit Care Med 2019; 20 (07) 638-644
- 7 McLendon D, Check J, Carteaux P. et al. Implementation of potentially better practices for the prevention of brain hemorrhage and ischemic brain injury in very low birth weight infants. Pediatrics 2003; 111 (4, pt 2): e497-e503
- 8 Mintzer JP, Parvez B, La Gamma EF. Umbilical arterial blood sampling alters cerebral tissue oxygenation in very low birth weight neonates. J Pediatr 2015; 167 (05) 1013-1017
- 9 Hüning BM, Horsch S, Roll C. Blood sampling via umbilical vein catheters decreases cerebral oxygenation and blood volume in preterm infants. Acta Paediatr 2007; 96 (11) 1617-1621
- 10 de Bijl-Marcus K, Brouwer AJ, De Vries LS, Groenendaal F, Wezel-Meijler GV. Neonatal care bundles are associated with a reduction in the incidence of intraventricular haemorrhage in preterm infants: a multicentre cohort study. Arch Dis Child Fetal Neonatal Ed 2020; 105 (04) 419-424
- 11 Ferreira DM, Girao ALA. Silva AVSE. et al. Application of a bundle in the prevention of peri-Intraventricular hemorrhage in preterm newborns. J Perinat Neonatal Nurs 2020; 34 (02) E5-E11
- 12 Dolfin T, Skidmore MB, Fong KW, Hoskins EM, Shennan AT. Incidence, severity, and timing of subependymal and intraventricular hemorrhages in preterm infants born in a perinatal unit as detected by serial real-time ultrasound. Pediatrics 1983; 71 (04) 541-546
- 13 Rumack CM, Manco-Johnson ML, Manco-Johnson MJ, Koops BL, Hathaway WE, Appareti K. Timing and course of neonatal intracranial hemorrhage using real-time ultrasound. Radiology 1985; 154 (01) 101-105
- 14 Rhee CJ, Kaiser JR, Rios DR. et al. Elevated diastolic closing margin is associated with intraventricular hemorrhage in premature infants. J Pediatr 2016; 174: 52-56
- 15 Vesoulis ZA, Flower AA, Zanelli S. et al. Blood pressure extremes and severe IVH in preterm infants. Pediatr Res 2020; 87 (01) 69-73
- 16 Vesoulis ZA, Bank RL, Lake D. et al. Early hypoxemia burden is strongly associated with severe intracranial hemorrhage in preterm infants. J Perinatol 2019; 39 (01) 48-53
- 17 Ng IHX, da Costa CS, Zeiler FA. et al. Burden of hypoxia and intraventricular haemorrhage in extremely preterm infants. Arch Dis Child Fetal Neonatal Ed 2020; 105 (03) 242-247
- 18 Sullivan BA, Wallman-Stokes A, Isler J. et al. Early Pulse oximetry data improves prediction of death and adverse outcomes in a two-center cohort of very low birth weight infants. Am J Perinatol 2018; 35 (13) 1331-1338
- 19 Sullivan BA, McClure C, Hicks J, Lake DE, Moorman JR, Fairchild KD. Early heart rate characteristics predict death and morbidities in preterm infants. J Pediatr 2016; 174: 57-62
- 20 Parry G, Tucker J, Tarnow-Mordi W. UK Neonatal Staffing Study Collaborative Group. CRIB II: an update of the clinical risk index for babies score. Lancet 2003; 361 (9371): 1789-1791
- 21 Inder T, Perlman J, Volpe J. Preterm intraventricular hemorrhage/posthemorrhagic hydrocephalus. In: Volpe J, Inder T, Darras B. et al, eds Volpe's Neurology of the Newborn. Philadelphia: Elsevier; 2018: 637-698
- 22 Nagraj VP, Sinkin RA, Lake DE, Moorman JR, Fairchild KD. Correction: Recovery from bradycardia and desaturation events at 32 weeks corrected age and NICU length of stay: an indicator of physiologic resilience?. Pediatr Res 2020; 88 (05) 821
- 23 Alonzo CJ, Nagraj VP, Zschaebitz JV, Lake DE, Moorman JR, Spaeder MC. Blood pressure ranges via non-invasive and invasive monitoring techniques in premature neonates using high resolution physiologic data. J Neonatal Perinatal Med 2020; 13 (03) 351-358
- 24 da Costa CS, Czosnyka M, Smielewski P, Austin T. Optimal mean arterial blood pressure in extremely preterm infants within the first 24 hours of life. J Pediatr 2018; 203: 242-248
- 25 Lampe R, Rieger-Fackeldey E, Sidorenko I. et al. Assessing key clinical parameters before and after intraventricular hemorrhage in very preterm infants. Eur J Pediatr 2020; 179 (06) 929-937
- 26 Rhee CJ, Kibler KK, Easley RB. et al. The diastolic closing margin is associated with intraventricular hemorrhage in premature infants. Acta Neurochir Suppl (Wien) 2016; 122: 147-150
- 27 O'Leary H, Gregas MC, Limperopoulos C. et al. Elevated cerebral pressure passivity is associated with prematurity-related intracranial hemorrhage. Pediatrics 2009; 124 (01) 302-309
- 28 Alderliesten T, Lemmers PMA, Smarius JJM, van de Vosse RE, Baerts W, van Bel F. Cerebral oxygenation, extraction, and autoregulation in very preterm infants who develop peri-intraventricular hemorrhage. J Pediatr 2013; 162 (04) 698-704.e2
- 29 Rhee CJ, da Costa CS, Austin T, Brady KM, Czosnyka M, Lee JK. Neonatal cerebrovascular autoregulation. Pediatr Res 2018; 84 (05) 602-610
- 30 Javorka K, Lehotska Z, Kozar M. et al. Heart rate variability in newborns. Physiol Res 2017; 66 (Suppl. 02) S203-S214
- 31 Noori S, Seri I. Hemodynamic antecedents of peri/intraventricular hemorrhage in very preterm neonates. Semin Fetal Neonatal Med 2015; 20 (04) 232-237
- 32 Vesoulis ZA, Whitehead HV, Liao SM, Mathur AM. The hidden consequence of intraventricular hemorrhage: persistent cerebral desaturation after IVH in preterm infants. Pediatr Res 2021; 89 (04) 869-877
- 33 Cimatti AG, Martini S, Galletti S. et al. Cerebral oxygenation and autoregulation in very preterm infants developing IVH during the transitional period: a pilot study. Front Pediatr 2020; 8: 381