Prevalence, Sonographic Patterns of Intraventricular Hemorrhage and Associated Risk Factors Among Preterm Neonates Admitted at Kenyatta National Hospital Newborn Unit

Abstract

Background: Intraventricular haemorrhage occurs when cerebral haemorrhage leaks into the brain's ventricular system. The prevalence is 5-27% globally and increases with prematurity. In Kenya, the incidence of neonatal IVF is about 8%. The prevalence is 33.8%, which is higher than the pooled global prevalence, but the sonographic findings of neonates and their correlation with gestational age have not been evaluated in the region. This study addressed this gap. We underline the role that imaging plays in managing and following up IVH cases. Broad objective: We described the prevalence, sonographic findings, IVH grading, and associated risk factors in preterm neonates admitted to Kenyatta National Hospital Newborn Intensive Care Unit (NICU) between 1st November 2022 and 1st June 2023 (8 months). Study design: Analytical cross-sectional study. Population: Preterm neonates who underwent cranial ultrasound within the 1st week of life Methodology: Cranial ultrasounds were conducted on 151 preterm neonates following prior parental or guardian consent. Imaging was performed by the principal investigator using a 7.5MHz micro convex transducer. Sonographic patterns and IVH grading, when present, were documented on a questionnaire. A radiologist validated these findings. Demographic and medical information such as age, gender, birth weight, Apgar score at 5 and 10 minutes, and neonatal complications were abstracted from in-patient files by a research assistant. Data analysis was performed using the International Business Machines (IBM) Statistical Package for Social Scientists (SPSS) for Windows, version 25.0. The data was uploaded to a spreadsheet and checked for typing errors and missing data. Inconsistent data was cross-checked in patient files and corrected before analysis. The distribution of continuous data was checked using the Schapiro-Wilks test and reported as either parametric or non-parametric. Demographic and medical data was summarized using frequency distributions and medians with interquartile ranges and presented in tables or charts. Sonographic findings and IVH grading were analyzed using frequencies and percentages. Maternal and neonatal risk factors for IVH were evaluated using the Chi-square test at a 95% CI. The p-value of <0.05 was statistically significant. Results: We evaluated 151 neonates (51.7% male and 49.3% female) with a median age of 3 days (IQR = 2-5 days). Most neonates were delivered moderate to late preterm (32 to 37 weeks) with a median birth weight of 1570 grams (IQR = 1320-1873.8 grams). Nearly all (98.7%) neonates had health complications, mainly respiratory distress (60.0%) and asphyxia (36.0%). Intraventricular hemorrhage was evident in 17.2%, with its prevalence found to be significantly higher when neonates were very preterm and born to mothers who had obstetric complications. The most common grade of IVH was grade 1, found in 69.0% of neonates. The odds IVH was 3.49 (95% CI = 1.30 - 8.40) times higher among neonates with poor Apgar scores at 5, p = 0.006, 4.75 (95% CI = 1.69 - 14.50) times higher among neonates with poor Apgar scores at 10 minutes, p = 0.003, and 3.12 (95% CI = 1.28 - 7.05) times higher among neonates who were born to mothers who were diagnosed with obstetric complications such as preeclampsia. After controlling for confounding, the adjusted odds for developing IVH was higher among neonates born to mothers with obstetric complications by 3.20 times (95% CI =1.30-7.87), p = 0.011. Conclusion: We diagnosed IVH in one in five preterm neonates. The affected mostly had mild IVH. Neonates who were delivered very preterm to mothers with obstetric complications such as preeclampsia and had poor Apgar scores at 5 and 10 minutes were 3.12, 3.49, and 4.75 times

more likely to develop IVH within the first seven days of life compared to those born to mothers with no obstetric complications and those with normal Apgar scores at 5 and 10 minutes. The presence of maternal complications increased the adjusted odds for IVH by 3.20 times.