Incidence And Risk Factors For Development Of Periventricular-Intraventricular Haemorrhage In The Very Preterm Babies Admitted To The New Born Unit At Kenyatta National Hospital

Abstract

Background Germinal matrix-intraventricular haemorrhage (GM-IVH) is bleeding into the brain’s ventricular system that originates from the capillary network of the primitive germinal matrix, which normally regresses before term. Also known as periventricular-intraventricular haemorrhage (PV-IVH), it involves the periventricular motor tracts, and is associated with both short and long-term complications including seizures, developmental delay and cerebral palsy. It is also associated with a higher mortality rate. PV-IVH has been shown to be inversely related to gestational age and birth weight, and is thus mostly observed among babies born before 32 weeks gestational age, who generally lie within the very low birth weight (VLBW) and/or extremely low birth weight (ELBW) categories. Clinical presentation varies, with most infants remaining asymptomatic. Others may demonstrate a sudden deterioration in clinical state, following which a diagnosis of PV-IVH may be suspected. Diagnosis, therefore, is mostly made on surveillance cranial ultrasonography, and this is the recommendation globally. Objectives The objective of this study was to determine the incidence, and describe any associated risk factors for intraventricular haemorrhage in the very preterm babies within the first 7 days of life. Participants and Methods This was a cohort study where two cranial sonography scans were carried out initially within 72 hours of life, and then at day 7 among neonates born at  32 weeks gestational age. Results and Conclusion A total of 195 neonates were recruited, and 144 (73.8%) of these survived to day 7 of life, with a male to female ratio of approximately 1:1. Median gestational age was 31 weeks (IQR 29 – 32), and the median birth weight was 1440g. Overall prevalence of PV-IVH was 8% (95% CI 4 to 12%), with majority (60%) being grade I haemorrhage, and the remainder 40% being grade II haemorrhage. Multivariate analysis revealed significant risk factors for PV-IVH as being severe RDS (p = 0.005), male gender (p = 0.035 ) and being small for gestational age (p = 0.001)