• About Us
    • Contact Us
    • Login
    • ObGFirst
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • COVID-19
About Us Contact Us Login ObGFirst
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • COVID-19
Grand Rounds

Is the Incidence of Intraventricular Hemorrhage Associated with Premature Births Decreasing?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • Up to one third of all infants < 28 weeks will have intraventricular hemorrhage (IVH)
  • Yeo et al. (Archives of Disease in Childhood – Fetal and Neonatal Edition, 2019) examined the trend and risk factors for IVH among infants <32 weeks gestation)

METHODS:

  • Population-based cohort study (1995 to 2012)
    • Australian and New Zealand Neonatal Network (ANZNN)
  • Participants
    • All preterm infants born <32 weeks gestation
  • Interventions
    • Comparison of incidence of IVH between 6-year epochs
    • 6-year epochs: Epoch 1: 1995 to 2000 | Epoch 2: 2001 to 2006 | Epoch 3: 2007 to 2012
  • Primary outcomes
    • Overall IVH and severe IVH incidence (Grade 3 and 4)
  • Secondary outcome
    • Combined outcome of severe IVH and/or death over time

RESULTS:

  • 60,068 infants
    • Overall survival to discharge increased over the three epochs from 89% to 93%
    • Increase seen in: Antenatal steroid usage | Increase in caesarean-section births
    • Decrease seen in: Infant intubation at birth | Low 5 min Apgar score | Sepsis
  • The percentage of infants with IVH decreased over the three epochs (p<0.001)
    • Epoch 1: 23.6%
    • Epoch 2: 21.3%
    • Epoch 3: 21.4%
  • Fewer surviving infants had severe IVH over time (p<0.001)
    • Epoch 1: 4.0%
    • Epoch 2: 3.3%
    • Epoch 3: 2.8%
  • There was significant reduction risk for severe IVH from epoch 1 to 3 when adjusting for perinatal confounders
    • Adjusted odds ratio (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 infant: 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 (born in outside centers and transported in to main center): AOR 1.6 (95% CI, 1.5 to 1.8)
    • Vaginal delivery: AOR 1.4 (95% CI, 1.3 to 1.6)
  • Study found protective effect related to preeclampsia

CONCLUSION:

  • Over time, more infants born <32 weeks gestation were surviving and incidence of severe IVH decreased
  • Decrease in IVH incidence may be related to reduced risk factor rates over the same time period
    • Use of antenatal steroids
    • Switch from intubation at birth to nasal CPAP
  • Authors note that factors are associated but do not necessarily cause severe IVH
  • Study confirms previous studies that preeclampsia may be protective for IVH and authors postulate
    • Angiogenic factors may play a role
    • Medications may impact rate of IVH

Learn More – Primary Sources:

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

Now You Can Get ObG Clinical Research Summaries Direct to Your Phone, with ObGFirst

Learn More »

image_pdfFavoriteLoadingFavorite
< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

Cesarean or Vaginal Delivery for Extremely Preterm Breech Singletons Less Than 28 Weeks?
Antenatal Corticosteroids – When to Administer?
Do Antenatal Corticosteroids Reduce Morbidity in Premature Neonates Prior to 24 weeks?
17-OHPC Treatment and Prevention of Preterm Birth: Does Timing Matter?

Sections

  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • COVID-19

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site