Incidence and risk factors for development of periventricular-intraventricular haemorrhage in the very preterm baby in the newborn unit at Kenyatta National Hospital

Abstract

Background: Periventricular-intraventricular haemorrhage (PV-IVH), is bleeding into the brain’s ventricular system and involves the periventricular motor tracts. Prevalence/incidence of 9.5-45% has been reported with the highest incidence being in babies born before 32weeks gestation. Overall incidence has declined over time. Clinical presentation varies, and diagnosis is mostly made on surveillance cranial ultrasonography as is the recommendation globally. This study evaluated the contribution of periventricular-intraventricular
haemorrhage to preterm morbidity and mortality within the New-Born Unit at the study facility, in the context of improved new-born care.
Objectives: The study objective was to determine incidence and describe risk factors for intraventricular haemorrhage in very preterm babies within the first 7 days of life.
Participants and Methods: Consecutive sampling of neonates born at  32weeks gestation was performed in this cohort study where two cranial sonography scans were carried out in the first week of life – initially within 72 hours of life, and then at day 7.
Results and Conclusion: Of the 195 participants, 144 (73.8%) survived to day 7 of life, with a male-to-female ratio of approximately 1:1. Median gestational-age was 31 weeks (IQR 29 – 32), and median birthweight was 1440g. Overall incidence of PV-IVH was 8% (95% CI 4 to 12%), with majority (60%) being grade I haemorrhage and 40% being grade II haemorrhage. Statistical analysis revealed significant risk factors for PV-IVH as being severe RDS (p = 0.005), male gender (p = 0.035) and being small for gestational age (p = 0.001).