Abstract
Background: Premature infants are known to be at increased risk for intraventricular hemorrhage (IVH) in the first week of life. IVH may be “mild” (grade I or II) or “severe” (grade III or IV). A classification of mild is less frequently associated with later morbidity. Severe grade IVH may be associated with death or severe neurodevelopmental disability. Mild IVH is generally considered a static, non-progressive disease. Thus, infants that do not present with IVH or who present with mild IVH are unlikely to advance to severe IVH. Consequently, after initial imaging demonstrates a normal result, subsequent head ultrasounds (HUS) may be unnecessary.Methods: This is a retrospective, single-center study. We identified all preterm infants with birth gestational age </= 32 0/7 weeks admitted to the University of Massachusetts Memorial Medical Center Neonatal Intensive Care Unit between January 1, 2011 and December 31, 2016 who received a head ultrasound (HUS) during hospitalization. Each individual ultrasound was classified according to the attending radiologist’s documentation. Grades of IVH were defined per the Papile classification. Initial HUS was defined as HUS performed on day of life 3-10. Every subsequent HUS throughout hospitalization was read and recorded.Results: We identified 682 eligible preterm infants. Of these, 88 were excluded for lack of HUS data, 237 had initial HUS out of inclusion timing window (day of life 3-10), and 4 were excluded for other conditions associated with intraventricular hemorrhage, leaving 353 infants for analysis. Initial findings of severe IVH were relatively rare in this cohort. Of the 343 (97%) infants who had mild IVH (grade II or less) at time of initial screening, only 4 (1.2%) progressed to severe (grade III or IV). Each of these infants required mechanical ventilation for at least 40 days.Conclusions: Based on the results of this analysis, premature infants who have a normal (no IVH) HUS or mild IVH (grade I or II) on initial routine screening HUS without other risk factors may not require follow-up HUS. Infants with prolonged mechanical ventilation may require further screening despite reassuring initial HUS findings.
Antenatal exposure to Ureaplasma species exacerbates bronchopulmonary dysplasia synergistically with subsequent prolonged mechanical ventilation in preterm infants
