Reduction of severe intraventricular hemorrhage, a tertiary single-center experience: incidence trends, associated risk
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ORIGINAL ARTICLE
Reduction of severe intraventricular hemorrhage, a tertiary single-center experience: incidence trends, associated risk factors, and hospital policy Wafa Sattam M. Alotaibi 1 & Nada S. Alsaif 1 & Ibrahim A. Ahmed 1,2 & Aly Farouk Mahmoud 2 & Kamal Ali 2 & Abdullah Hammad 3 & Omar S. Aldibasi 1,4 & Saif A. Alsaif 1,2 Received: 29 November 2019 / Accepted: 13 April 2020 # The Author(s) 2020
Abstract Objectives To determine the incidence, trends, maternal and neonatal risk factors of severe intraventricular hemorrhage (IVH) among infants born 24–32 weeks and/or < 1500 g, and to evaluate the impact of changing of hospital policies and unit clinical practice on the IVH incidence. Study design Retrospective chart review of preterm infants with a gestational age (GA) of 24–326 weeks and/or weight of < 1500 g born at King Abdulaziz Medical City–Riyadh (KAMC-R), Saudi Arabia, from 2016 to 2018. Multivariate logistic regression model was constructed to determine the probability of developing severe IVH and identify associations with maternal and neonatal risk factors. Results Among 640 infants, the overall incidence of severe IVH was 6.4% (41 infants), and its rate decreased significantly, from 9.4% in 2016 to 4.5% and 5% in 2017 and 2018 (p = 0.044). Multivariate analysis revealed that caesarian section delivery decreased the risk of severe IVH in GA group 24–27 weeks (p = 0.045). Furthermore use of inotropes (p = 0.0004) and surfactant (p = 0.0003) increased the risk of severe IVH. Despite increasing use of inotropes (p = 0.024), surfactant therapy (p = 0.034), and need for delivery room intubation (p = 0.015), there was a significant reduction in the incidence of severe IVH following the change in unit clinical practice and hospital policy (p = 0.007). Conclusion Cesarean section was associated with decreased all grades of IVH and severe IVH, while use of inotropes was associated with increased severe IVH. The changes in hospital and unit policy were correlated with decreased IVH during the study period. Keywords Neonatology . Prematurity . IVH . Neurodevelopmental
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00381-020-04621-7) contains supplementary material, which is available to authorized users. * Saif A. Alsaif [email protected] 1
King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
2
Neonatal Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
3
Medical Imaging Department, Pediatric Radiology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
4
Department of Bioinformatics and Biostatistics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
Abbreviations ANOVA Analysis of variance C/S Caesarian section CPR Cardiopulmonary resuscitation GA Gestational age HFOV High-frequency oscillatory ventilation IVH intraventricular hemorrhage KAMC King Abdulaziz Medical City NICHD National Institute of Child Health and Human Development NICU Neonatal intensive care unit TIPP Trial o
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