Clinical Variables Associated With Grade III and IV Intraventricular Hemorrhage (IVH) in Preterm Infants Weighing Less Than 750 Grams

Abstract

Background: Despite innovative advances in neonatal medicine, intraventricular hemorrhage (IVH) continues to be a significant complication in neonatal intensive care units globally.

Objective: The study aimed to discern the variables heightening the risk of severe IVH (Grade III and IV) in extremely premature infants weighing less than 750 grams. We postulated that a descending hematocrit (Hct) trend during the first week of life could serve as a predictive marker for the development of severe IVH in this vulnerable population.

Methods: This retrospective case-control study encompassed infants weighing less than 750 grams at birth, diagnosed with Grade III and/or IV IVH, and born in a tertiary center from 2009 to 2014. A group of 17 infants with severe IVH was compared with 14 gestational age-matched controls. Acid-base status, glucose, fluid goal, urine output, and nutrient (caloric and protein) intake during the first four days of life were meticulously evaluated. Statistically significant variables from baseline data were further analyzed via univariable and multivariable logistic regression analyses, ensuring control for potential confounding variables.

Results: The univariate logistic regression model delineated odds ratios (ORs) of 0.842 for day 2 average Hct (confidence interval [CI], 0.718-0.987) and 0.16 for urine output on day 3 (CI, 0.024-1.056), with the remaining six variables demonstrating no significant association. In the post-multivariable regression analysis, day 2 Hct was the only significant variable (OR, 0.731; 95% CI, 0.537-0.995; P=0.04). The receiver operating characteristic (ROC) curve analysis portrayed an area under the curve of 71% for the day 2 Hct variable.

Conclusion: The study revealed that a dip in Hct on day 2 of life augments the likelihood of Grade III and IV IVH among extremely premature infants with a birth weight of less than 750 grams. This insight amplifies our understanding of risk factors associated with severe IVH development in extremely preterm infants, potentially aiding in refining preventive strategies and optimizing clinical management and treatment of these affected infants.

Keywords: birth weight; birth weight below 750 grams; extremely preterm infants; gestational age; hematocrit; intraventricular hemorrhage (ivh); neonates; retrospective study.

Figure 1. Flowchart of study population selection

Figure 2. ROC curve analysis for day 2 average Hct, day 1 average PCO2, and day 3 urine output

D1: day 1; D2: day 2; D3: day 3; Hct: hematocrit; PCO2: partial pressure of carbon dioxide; ROC: receiver operating characteristic; UO: urine output