Intraventricular hemorrhage profile in very low birth weight preterm infants (< 1000 g and ≥ 1000 g) at a tertiary center in São Paulo State over a decade.

objectiveThe better survival of preterm infants in recent years raises concerns about the risk of Intraventricular Hemorrhage (IVH). The authors investigated the incidence, risk factors, severity, and mortality of IVH in Very Low Birth Weight (VLBW) infants, comparing those < 1000 g with those weighing 1000 g ‒ 1499 g.

methodsThis is a cohort of VLBW infants admitted from 2009‒2018. All neonates with gestational age between 24‒36 weeks, weighing from 400 g to 1499 g, and who underwent cranial ultrasound in the first 72-hours of life were included. Independent variables were maternal, gestational, birth, and neonatal data. Outcomes were IVH (all grades) and severe IVH (grades 3 and 4) in preterm infants < 1000 g and in those ≥ 1000 g.

resultsA total of 724 VLBW infants were studied, 37% of these weighing < 1000 g. The incidence of IVH was 32% and was more frequent in those < 1000 g (50.5%) compared with those ≥ 1000 g (21.5%). In preterm infants < 1000 g, gestational age and patent ductus arteriosus were associated with IVH, and severe IVH. In the group ≥ 1000 g, IVH was associated with preeclampsia, first-minute Apgar, use of vasoactive drugs and surfactant. The mortality of preterm infants with IVH was 35%; in severe cases, it reached 64.5% in those < 1000 g and 41% in those ≥ 1000 g.

conclusionsIVH is frequent and severe, with a high mortality rate in VLBW infants, especially in those < 1000 g. Several risk factors for IVH are potentially preventable and most of them reflect the role of hemodynamic instability in the occurrence of IVH. These results can guide obstetricians and neonatologists in the implementation of good care practices.