Comprehensive evaluation of risk factors for intraventricular hemorrhage in preterm neonates: a systematic review and meta-analysis

Intraventricular hemorrhage (IVH) is a major cause of morbidity and mortality among preterm neonates, making early identification of risk factors critical to improving outcomes. Understanding both clinical conditions and therapeutic interventions associated with IVH can guide prevention and management strategies. A systematic review and meta-analysis were conducted, incorporating 30 studies that investigated various risk factors for IVH. The studies were categorized based on the clinical conditions and therapeutic interventions involved. The data were analyzed using pooled relative risks (RR) and heterogeneity assessments, including I2 values and P-values. The analysis revealed several significant clinical risk factors for IVH. Male gender was associated with a 15% increased risk of IVH (pooled RR: 1.15, 95% CI 1.00-1.32), while low birth weight (< 1000g) was linked to a 94% increased risk (pooled RR: 1.94, 95% CI 1.38-2.73). Other significant factors included the presence of Apgar ≤ 5 or 7 (pooled RR: 2.14, 95% CI 1.69-2.72), asphyxia (pooled RR: 1.70, 95% CI 1.26-2.28), and thrombocytopenia (pooled RR: 1.34, 95% CI 1.10-1.62). Neonatal conditions such as respiratory distress syndrome (RDS) and hyaline membrane disease (HMD) were also found to increase IVH risk significantly. In terms of therapeutic interventions, antenatal steroids were associated with a reduced risk of IVH (pooled RR: 0.79, 95% CI 0.70-0.89), while mechanical ventilation, the use of catecholamines, surfactant administration increased IVH risk significantly (pooled RR for mechanical ventilation: 3.27, 95% CI 2.77-3.86; pooled RR for surfactant: 2.32, 95% CI 1.61-3.35). Several clinical factors and therapeutic interventions are associated with the risk of IVH in neonates. These findings emphasize the importance of early identification and management of high-risk neonates, as well as the need for further research to refine prevention strategies.