A Prospective Study to Determine Prevalence and Risk Factors for Intraventricular Hemorrhage in Preterm Neonates

Abstract

Background

Intraventricular hemorrhage (IVH) is the most common intracranial bleeding in preterm neonates and is linked to significant long-term neurodevelopmental morbidity. Routine cranial ultrasound (cUSG) screening recommendations, along with data on IVH prevalence and risk factors in India—especially in late preterm infants—are limited.

Objectives

This study aimed to determine IVH prevalence across preterm gestational ages (<37 weeks), identify maternal and neonatal risk factors for IVH, and evaluate IVH burden in late preterms in a tertiary care neonatal intensive care unit in Western Maharashtra.

Methods

In this single-center, prospective observational study from December 2020 to February 2022, 421 preterm neonates admitted within 24 h of birth received cUSG between days 4 and 7 of life. IVH was graded using the Papile classification. Maternal and neonatal data were collected via standardized forms. IVH prevalence was calculated, and univariate and multivariate logistic regression analyses identified independent risk factors. Late preterm infants (34-36 + 6 weeks) were analyzed separately.

Results

Of 421 preterm neonates, overall IVH prevalence was 28.27%, highest in those <28 weeks (62.5%) and birth weight <1,000 g (55.1%). IVH grades were: I (14.7%), II (10.7%), III (2.1%), IV (0.7%); 6.7% had other central nervous system abnormalities. Multivariate analysis showed weight (adjusted OR 2.13; 95% CI 1.27-3.56; P = .004), mechanical ventilation (adjusted OR 2.10; 95% CI 1.15-3.84; P = .016), and early-onset sepsis (adjusted OR 1.81; 95% CI 1.07-3.08; P = .027) as independent predictors. In late preterm neonates (n = 233), IVH prevalence was 19.3%, with birth weight <1,500 g (adjusted OR 5.35; 95% CI 1.90-15.07; P = .002) and mechanical ventilation (adjusted OR 3.21; 95% CI 1.24-8.31; P = .016) as independent risk factors.

Conclusions

IVH is a major complication across preterm ages, affecting nearly one-fifth of late preterm infants. Prevalence in <32 weeks neonates matches that of developed countries. Low birth weight, mechanical ventilation, and early sepsis heighten risk. Routine cUSG screening should include late preterm neonates, and preventing hemodynamic instability and sepsis could reduce IVH and neurodevelopmental issues.