Abstract Ref Number = APCP1053
DETECTION RATE, RISK FACTORS, AND OUTCOMES OF INTRAVENTRICULAR HEMORRHAGE IN PRETERM INFANTS
Putri Marsubrin,Dinarda Ulf Nadobudskaya,Hardya Gustada Hikmahrachim,Evita Karianni Bermanshah Ifran
Neonatology Division Department of Pediatric and Adolescent Health Cipto Mangunkusumo General Hospital Jakarta Indonesia Faculty of Medicine Universitas Indonesia Department of Pediatrics and Adolescent Health, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
Background : Intraventricular hemorrhage (IVH) is a leading cause of mortality and neurodevelopmental disabilities in preterm infants. In fact, IVH can be diagnosed early by cranial ultrasonography (cUS). The assessment of maternal, delivery, and neonatal factors are important to anticipate IVH. This study aims to identify the detection rate, risk factors, and outcomes of IVH in preterm infants.
Material : A retrospective cohort study was conducted in Cipto Mangunkusumo General Hospital, Jakarta, from January to June 2016. Included were preterm infants born with gestational age of 34 weeks, had cUS examination done before discharge or death, and complete medical record data. Cases with other intracranial pathology found during cUS were excluded.
Results : From 116 preterm infants underwent cUS, only 89 cases with complete medical record were analyzed. IVH was detected on 24/89 infants with grade I, II, III, and IV consecutively 16, 4, 2, and 2 cases. Timing of first cUS was 8(5:16) days. About 17/24 cases were detected during first cUS at 6(4:14) days and the rest in second cUS. There was no periventricular leukomalacia nor post hemorrhagic hydrocephalus detected. Risk factors were ELBW [RR 10.61(2.4–46.5)], VLBW [RR 6.9(1.6–29.76)], gestational age 28 weeks [RR 3.45(1.56–7.61)], APGAR score at 5 minute <7 [RR 3.54(1.45–8.64)], intubation during resuscitation [RR 1.63(1.03-2.58)], history of invasive ventilation [RR 1.50(1.08–2.1)], PDA [RR 4.15(1.85–9.28)], hypercarbia [RR 4.49(2.12–9.51)], seizure [RR 3.6(1.6–8.12)], low hemoglobin/hematocrit [RR 3.87(1.17–12.75)], and thrombocytopenia [RR 2.60(1.16–5.88)]. The all-cause mortality rate was 45.8% (p<0.001). Infants with IVH had longer length of stay (29 vs. 26 days).
Conclusions : This study found that the proportion of IVH was quite high with a devastating mortality rate. Further analysis is needed to determine the contribution of IVH to mortality. Serial cUS and long term monitoring should be performed in preterm infants with IVH risk factors.
Keywords: intraventricular hemorrhage preterm infants cranial ultrasonography