Improving incidence trends of severe intraventricular haemorrhages in preterm infants <32 weeks gestation: a cohort study

ObjectiveTo describe the trend and risk factors for severe intraventricular haemorrhage (IVH) among infants <32 weeks gestation.DesignPopulation-based cohort study.SettingAustralia and New Zealand.PatientsAll preterm infants <32 weeks gestation in the Australian and New Zealand Neonatal Network (ANZNN) from 1995 to 2012.InterventionsComparison of IVH incidence between 6-year epochs.Main outcome measuresOverall IVH and severe IVH incidence.ResultsA total of 60 068 infants were included, and overall survival to discharge increased from 89% to 93% over the three epochs. As the percentage of infants with IVH decreased from 23.6% to 21.3% and 21.4% (p<0.001) from epoch 1 to 3, respectively, fewer survivors had severe IVH (4.0%, 3.3% and 2.8%, respectively, p<0.001). Over time, there were fewer antenatal complications, higher antenatal steroid usage and more caesarean-section births. Fewer infants were intubated at birth, had low 5 min Apgar score, had sepsis or pneumothorax needing drainage. Adjusted for perinatal confounders, there was significant reduction in odds of severe IVH from epoch 1 to 3 (adjusted OR (AOR) 0.8, 95% CI 0.7 to 0.9). Factors associated with development of severe IVH include no antenatal steroids (AOR 1.7, 95% CI 1.5 to 1.9), male (AOR 1.3, 95% CI 1.2 to 1.4), 5 min Apgar score <7 (AOR 2.0, 95% CI 1.9 to 2.2), intubated at birth (AOR 2.0, 95% CI 1.8 to 2.2), extremely low gestational age (AOR 4.0, 95% CI 3.7 to 4.4), outborn (AOR 1.6, 95% CI 1.5 to 1.8) and vaginal delivery (AOR 1.4, 95% CI 1.3 to 1.6).ConclusionsAlong with increased survival among infants born <32 weeks gestation, the incidence of severe IVH has decreased over the 18 years, especially in the most recent period. This coincided with reduction in rates of risk factors for severe IVH development.

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Massive blood transfusion in relation to delivery: incidence, trends and risk factors: a population‐based cohort study

BJOG An International Journal of Obstetrics & Gynaecology ◽

10.1111/1471-0528.15927 ◽

2019 ◽

Vol 126 (13) ◽

pp. 1577-1586 ◽

Cited By ~ 6

Author(s):

L Thurn ◽

A Wikman ◽

M Westgren ◽

PG Lindqvist

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Blood Transfusion ◽

Population Based ◽

Massive Blood Transfusion ◽

Incidence Trends

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Mortality Predictive Risk Factors of Limits-Of-Viability Preterm Infants at 23 And 24 Weeks Gestation

Journal of Pediatrics & Neonatal Biology ◽

10.33140/jpnb.04.03.03 ◽

2019 ◽

Vol 4 (3) ◽

Keyword(s):

Risk Factors ◽

Preterm Infants ◽

Gestational Age ◽

Survival Rates ◽

Population Based ◽

P Value ◽

Antenatal Steroids ◽

Risk Of Mortality ◽

Predictive Risk ◽

Associated Risk Factors

Objective: The purpose of this study was to examine perinatal and postnatal events associated with neonatal mortality among 23 and 24 weeks gestation preterm infants. Methods: A population-based retrospective study of infants born at 23 and 24 weeks gestational age over a two-andhalf- year period. Results: A hundred and five preterm infants were investigated during the period of the study: 60 infants born at 23 weeks gestation and 45 infants born at 24 weeks gestation. In total, 79 infants were admitted to the NICU (75%). Twenty-six infants died in the delivery room. Twenty-six infants died within the first two weeks of life (33%) and 12 died beyond the first two weeks of life (15%). The survival rates for infants admitted to the NICU were 35% and 66% for 23 and 24 weeks infants, respectively. Altogether, 41 of all NICU-admitted infants remained alive until discharge (52%). (Figure 1) The majority of deaths occurred during the first two weeks of life (26/38; 68%).Tthe most associated risk factors were a lack of antenatal steroid ( p value < .001), bruises (0.002), gelatinous skin (0.032), and IVH (0.03) . Severe respiratory failure was the main cause of death. Failure to extubate from a respirator by two weeks of age with an FIO2 requirement > 50% was the main risk factor associated with death beyond two weeks of life (OR > 10.0 and p value of< 0.001).In comparison to mothers who did not receive antenatal steroids, an incomplete course showed a significant but lower risk of mortality (OR=3 vs. 13 and P value 0.001 vs 0.3). The rate of ANS administration approached 90% in 24 weeks gestation age vs 53% in the 23 weeks age group. The tendency to perform CS was < 10% in 23 weeks and up to 28 % in 24 weeks. Attending neonatologists decided to offer resuscitation in 93 % of 24 weeks versus 65% of 23 weeks newborn. Conclusions: Antenatal steroids, the degree of immaturity, a birth weight less than 750 grams, and need for IPPV ventilation while requiring more than 50% FIO2 at two weeks of age were the circumstances most associated with death. The survival rates until discharge for 23 and 24 weeks gestational age infants were 35% and 66%. Resuscitation selection criteria for 23 weeks gestation would provide a reasonable platform for forming an approach towards this particular gestational age.

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Massive Blood Transfusion in Relation to Delivery: Incidence, Trends, and Risk Factors: A Population-based Cohort Study

Obstetric Anesthesia Digest ◽

10.1097/01.aoa.0000693684.70869.3a ◽

2020 ◽

Vol 40 (3) ◽

pp. 125-126

Author(s):

L. Thurn ◽

A. Wikman ◽

M. Westgren ◽

P.G. Lindqvist

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Blood Transfusion ◽

Population Based ◽

Massive Blood Transfusion ◽

Incidence Trends

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Intraventricular haemorrhage in a Ugandan cohort of low birth weight neonates: the IVHU study

BMC Pediatrics ◽

10.1186/s12887-020-02464-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

R. MacLeod ◽

J. N. Paulson ◽

N. Okalany ◽

F. Okello ◽

L. Acom ◽

...

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Low Birth Weight ◽

Intraventricular Haemorrhage ◽

Sub Saharan Africa ◽

Cranial Ultrasound ◽

High Grade ◽

Odds Ratios ◽

Antenatal Steroids ◽

Eastern Uganda

Abstract Background Globally, 15 million neonates are born prematurely every year, over half in low income countries (LICs). Premature and low birth weight neonates have a higher risk of intraventricular haemorrhage (IVH). There are minimal data regarding IVH in sub-Saharan Africa. This study aimed to examine the incidence, severity and timing of and modifiable risk factors for IVH amongst low-birth-weight neonates in Uganda. Methods This is a prospective cohort study of neonates with birthweights of ≤2000 g admitted to a neonatal unit (NU) in a regional referral hospital in eastern Uganda. Maternal data were collected from interviews and medical records. Neonates had cranial ultrasound (cUS) scans on the day of recruitment and days 3, 7 and 28 after birth. Risk factors were tabulated and are presented alongside odds ratios (ORs) and adjusted odds ratios (aORs) for IVH incidence. Outcomes included incidence, timing and severity of IVH and 28-day survival. Results Overall, 120 neonates were recruited. IVH was reported in 34.2% of neonates; 19.2% had low grade (Papile grades 1–2) and 15% had high grade (Papile grades 3–4). Almost all IVH (90.2%) occurred by day 7, including 88.9% of high grade IVH. Of those with known outcomes, 70.4% (81/115) were alive on day 28 and survival was not associated with IVH. We found that vaginal delivery, gestational age (GA) < 32 weeks and resuscitation in the NU increased the odds of IVH. Of the 6 neonates who received 2 doses of antenatal steroids, none had IVH. Conclusion In this resource limited NU in eastern Uganda, more than a third of neonates born weighing ≤2000 g had an IVH and the majority of these occurred by day 7. We found that vaginal birth, earlier gestation and need for resuscitation after admission to the NU increased the risk of IVH. This study had a high rate of SGA neonates and the risk factors and relationship of these factors with IVH in this setting needs further investigation. The role of antenatal steroids in the prevention of IVH in LICs also needs urgent exploration.

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