Global incidence proportion of intraventricular haemorrhage of prematurity: a meta-analysis of studies published 2010–2020

ObjectiveTo investigate differences and calculate pooled incidence of any intraventricular haemorrhage (IVH), severe IVH (Grade III/IV, sIVH) and ventriculoperitoneal shunt (VPS) placement in preterm infants across geographical, health and economic regions stratified by gestational age (GA).DesignMEDLINE, Embase, CINAHL and Web of Science were searched between 2010 and 2020. Studies reporting rates of preterm infants with any IVH, sIVH and VPS by GA subgroup were included. Meta-regression was performed to determine subgroup differences between study designs and across United Nations geographical regions, WHO mortality strata and World Bank lending regions. Incidence of any IVH, sIVH and VPS by GA subgroups<25, <28, 28–31, 32–33 and 34–36 weeks were calculated using random-effects meta-analysis.ResultsOf 6273 publications, 97 met inclusion criteria. Incidence of any IVH (37 studies 87 993 patients) was: 44.7% (95% CI 40.9% to 48.5%) for GA <25 weeks, 34.3% (95% CI 31.2% to 37.6%) for GA <28 weeks, 17.4% (95% CI 13.8% to 21.6%) for GA 28–31 weeks, 11.3% (95% CI 7.3% to 17.0%) for GA32–33 weeks and 4.9% (95% CI 1.4% to 15.2%) for GA 34–36 weeks. Incidence of sIVH (49 studies 328 562 patients) was 23.7% (95% CI 20.9% to 26.7%) for GA <25 weeks, 15.0% (95% CI 13.1% to 17.2%) for GA <28 weeks, 4.6% (95% CI 3.5% to 6.1%) for GA 28–31 weeks, 3.3% (95% CI 2.1% to 5.1%) for GA 32–33 weeks and 1.8% (95% CI 1.2% to 2.8%) for GA 34–36 weeks. Europe had lower reported incidence of any IVH and sIVH relative to North America (p<0.05). Proportion of VPS across all GA groups was 8.4% (95% CI 4.7% to 14.7%) for any IVH and 17.2% (95% CI 12.2% to 26.2%) for sIVH. Heterogeneity was high (I2 >90%) but 64%–85% of the variance was explained by GA and study inclusion criteria.ConclusionsWe report the first pooled estimates of IVH of prematurity by GA subgroup. There was high heterogeneity across studies suggesting a need for standardised incidence reporting guidelines.

Outcome of non-cooled asphyxiated infants with under-recognised or delayed-onset encephalopathy

ObjectiveTo describe the clinical characteristics, MRI findings and neurodevelopmental outcome of infants with documented perinatal asphyxia and seizure onset within 24 hours after birth who were not selected for therapeutic hypothermia (TH).DesignRetrospective cohort study.Setting and patients(Near-)term infants with documented perinatal asphyxia referred to two Dutch level III neonatal units with neonatal encephalopathy (NE) and seizures <24 hours after birth not treated with TH. Infants with a diagnosis other than NE following perinatal asphyxia causing the seizures were excluded.Main outcome measuresClinical characteristics, findings on cranial MRI performed within 8 days after birth and neurodevelopmental outcome assessed using the Griffiths Mental Development Scales at 18 months or Bayley Scales of Infant and Toddler Development–Third Edition at 2 years of age.Results39 infants were included. All had abnormalities on MRI. Predominant white matter/watershed injury was the most common pattern of injury, 23 (59%). 7 (18%) infants had predominant basal ganglia/thalamus injury, 3 (8%) near total brain injury, 5 (13%) arterial ischaemic stroke, 1 (3%) an intraventricular haemorrhage. Adverse outcome was seen in 51%: 6 died, 11 developed cerebral palsy (spastic n=8, dyskinetic n=3), 2 had neurodevelopmental delay, 1 had severe hearing impairment.ConclusionsAll infants with documented perinatal asphyxia and seizure onset within 24 hours after birth who did not receive TH had abnormalities on MRI. 51% had an adverse outcome. Better methods for recognition of infants who might benefit from TH and careful neurodevelopmental follow-up are urgently needed.

Blood pressure changes during the first 24 hours of life and the association with the persistence of a patent ductus arteriosus and occurrence of intraventricular haemorrhage

Very low birthweight (VLBW) infants are at risk of intraventricular haemorrhage (IVH) and delayed closure of ductus arteriosus. We investigated mean arterially recorded blood pressure (MAP) changes during the first day of life in VLBW infants as potential risk factors for a patent ductus arteriosus (PDA) and IVH. This retrospective cohort study exploring MAP changes during adaption and risk factors for a PDA and IVH comprised 844 VLBW infants admitted to the Helsinki University Children’s Hospital during 2005–2013. For each infant, we investigated 600 time-points of MAP recorded 4–24 hours after birth. Based on blood pressure patterns revealed by a data-driven method, we divided the infants into two groups. Group 1 (n = 327, mean birthweight = 1019 g, mean gestational age = 28 + 1/7 weeks) consisted of infants whose mean MAP was lower at 18–24 hours than at 4–10 hours after birth. Group 2 (n = 517, mean birthweight = 1070 g, mean gestational age = 28 + 5/7 weeks) included infants with a higher mean MAP at 18–24 hours than at 4–10 hours after birth. We used the group assignments, MAP, gestational age at birth, relative size for gestational age, surfactant administration, inotrope usage, invasive ventilation, presence of respiratory distress syndrome or sepsis, fluid intake, and administration of antenatal steroids to predict the occurrence of IVH and use of pharmacological or surgical therapy for a PDA before 42 weeks of gestational age. Infants whose mean MAP is lower at 18–24 hours than at 4–10 hours after birth are more likely to undergo surgical ligation of a PDA (odds ratio = 2.1; CI 1.14–3.89; p = 0.018) and to suffer from IVH (odds ratio = 1.83; CI 1.23–2.72; p = 0.003).

Five-minute Apgar score and outcomes in neonates of 24–28 weeks’ gestation

ObjectivesTo assess associations between 5 min Apgar score and mortality and severe neurological injury (SNI) and to report test characteristics in preterm neonates.Design, setting and patientsRetrospective cohort study of neonates 240 to 286 weeks’ gestation born between 2007 and 2016 and admitted to neonatal units in 11 high-income countries.Exposure5 min Apgar score.Main outcome measuresIn-hospital mortality and SNI defined as grade 3 or 4 periventricular/intraventricular haemorrhage or periventricular leukomalacia. Outcome rates were calculated for each Apgar score and compared after adjustment. The diagnostic characteristics and ORs for each value from 0 versus 1–10 to 0–9 versus 10, with 1-point increments were calculated.ResultsAmong 92 412 included neonates, as 5 min Apgar score increased from 0 to 10, mortality decreased from 60% to 8%. However, no clear increasing or decreasing pattern was identified for SNI. There was an increase in sensitivity and decrease in specificity for both mortality and SNI associated with increasing scores. The Apgar score alone had an area under the curve of 0.64 for predicting mortality, which increased to 0.73 with the addition of gestational age.ConclusionsIn neonates of 24–28 weeks’ gestation admitted to neonatal units, higher 5 min Apgar score was associated with lower mortality in a graded manner, while the association with SNI remained relatively constant at all scores. Among survivors, low Apgar scores did not predict SNI.

Maternal and fetal outcome in preterm premature rupture of membrane

Background: The objective was to study the maternal and fetal outcome in women with premature rupture of membranes.Methods: It was a prospective analytic hospital based study, study population include 100 obstetrics cases of singleton pregnancy with gestational age of 28 week to 36 week with spontaneous rupture of membranes over a period of 2 years, 100 pregnant women without PROM upto 36 completed week taken as control. Detailed clinical examination of the patient was done to see any co-morbidity. Data was collected using a performa. Detailed workup including history, general physical examination, abdominal and pelvic examination and relevant specific investigation were noted.Results: PROM occurs more frequently in primigravida compared to that of multigravida (p=0.679). Risk factors unknown factors 71% and history of coitus 5% UTI (p=0.001) which was highly significant, incidence of LSCS were found higher in PROM than in controls (p<0.05) which was statistically significant. Out of all vaginal deliveries, percentage of patients who had spontaneous labour were 69.86%, while 30.14% were induced, 60% of cases was spontaneous out of which 51% delivered successfully vaginally and, 9% landed in cesarean section. 16% were given prostaglandin gel out of which 10% delivered successfully. 8% were augmented by oxytocin of which 6% delivered successfully and 2% landed in cesarean section. Out of 100 cases studies, 24% accounted for respiratory distress syndrome, while 6% in control group. 12% septicemia in study group (p=0.001) which was highly significant value, while conjunctivitis, neonatal jaundice (hyperbilirubinaemia) and intraventricular haemorrhage accounted for 2%, 3%, and 2% each.Conclusions: Present study concluded that most common cause of PPROM was unknown. Most common maternal morbidity was puerperal fever and neonatal morbidity was respiratory distress. Maternal and fetal morbidity increases with increase in duration between rupture of membranes and delivery of fetus, so augmentation of labour should be done.

Frequency of Complications in Neonates with Low Birth Weight

Objective: To identify and determine the frequency of complications in neonates with low birth weight. Methodology: This cross sectional study was conducted at Khairpur Medical College and Lady Willingdon Hospital, Khairpur Mirs from January 2018 to July 2021. Two hundred (n=200) neonates with low birth weight (<2500 grams) were recruited and frequency of different complications were observed. Results: The mean age of the neonates was 10.50 ± 4.34 days. Of the 200 neonates with low birth weight, 132 neonates (66%) presented with various complications; however 68 neonates (34%) were normal and without complications. Of the 200 neonates with low birth weight, the following complications were observed, hypoglycaemia (14.5%), jaundice (12.5%), respiratory distress syndrome (8%), feeding problems (8%), congenital cardiac defects (5%), hypothermia (4%), other complications such as sepsis (2%), apnea of prematurity (2%), intraventricular haemorrhage (2%), and more than 1 complications (16 neonates, 8%). Conclusions: In conclusion, hypoglycaemia and jaundice were the common complications associated with low birth weight in neonates. Advanced maternal age during childbirth, stress, lower socioeconomic conditions, consanguineous marriages, lower body mass index and maternal illness such as preeclampsia and anaemia were the risk factors of low birth weight observed in our study. Risk factors may be identified earlier in order to lessen the morbidities and mortality in low birth weight neonates.

Upward gaze palsy and convergence insufficiency as a rare presentation of primary intraventricular haemorrhage

A primary intraventricular haemorrhage (PIVH) usually presents with non-localised neurological symptoms since the haematoma is limited to the ventricles. However, it is sometimes associated with focal neurological signs, whose pathophysiologies are not confirmed. Here, we report on a case of PIVH who showed rare manifestations in the acute stage: upward gaze palsy and convergence insufficiency. The CT and MRI showed intraventricular haematoma without evidence of parenchymal haemorrhage, local mass effect around midbrain or hydrocephalus. There had been bilateral papilloedema, and it resolved along with improvement of the ophthalmic symptoms, suggesting a possible causal relation to increased intracranial pressure. The ophthalmic abnormalities suggested injury of the rostral part of the midbrain, especially the region around the dorsal midbrain tectum. It should be known that PIVH is one of the causes of acutely developing upward gaze palsy and convergence insufficiency.

IMPACT OF MULTIPLE BIRTHS ON THE OUTCOME IN EXTREMELY LOW BIRTH WEIGHT NEWBORNS

Objective: To evaluate the outcome of the extremely low birth weight newborns (ELBWNs) from single and twin pregnancies. Material and methods: The study lasts from 2005 to 2017 and includes all life born ELBWNs treated in University Hospital, Pleven, Bulgaria. Patients' groups: singletons (1) and twins (2); twins conceived naturally(2.1) and after assisted reproductive technologies – ART(2.2). Results: One hundred and eighty two (182) ELBWNs are examined, 65 (35.7%) of them are twins. The twins, compared to singletons, are significantly more often conceived by ART (47.7 vs 4.3%, p<0.001) and significantly more rarely infected prenatally (18 vs 41%, p 0.002). The survival rate is 51.3% for singletons and 56.6% for twins, NS. Survived twins (n 37) achieve later their optimal nutritive tolerance (30±11 vs 25±10 days, p 0.046), require more blood transfusions (3.6±1.9 vs 2.6±1.8 per patient, p 0.009) and longer mechanical ventilation (16±15 vs 9±12 days, p 0.03) than survival singletons (n 60). The twins suffer more often from intraventricular haemorrhage (46 vs 18%, p 0.004), patent ductus arteriosus (35 vs 15%, p 0.02) and long-term complications (51 vs 30%, p 0.04) than singletons. ART-twins (n 31)compared to the subgroup 2.1 (n 34) are more frequently intubated in the delivery room (81 vs. 50%, p 0.01)but suffer less frequently from nosocomial infections (53 vs. 85%, p 0.03). Conclusions: According to our data, ELBW-twins frequently suffer from respiratory, haemorrhagic, and gastrointestinal problems than ELBW-singletons, resulting in more long-term complications. Our study proves that ART does not influence the outcome in multiples.