5952 The determinants of intraventricular hemorrhage among neonates at a public hospital in South Africa (2013–2020)

Objectives Intraventricular hemorrhage (IVH) is a significant cause of morbidity and mortality among low birth weight (LBW) neonates despite the improvement in the neonatal intensive care unit.¹ IVH is commonly seen in preterm and LBW neonates.² Identifying risk factors associated with IVH is very important, as it helps prevent neurological problems and minimize the general burden of neurological sequelae.³ Methods In this retrospective study, a total of 2102 neonates, with birth weights ranging from 500g to 2500g, were reviewed. They were admitted to the Neonatal Intensive Care Unit (NICU) at Charlotte Maxeke Johannesburg Academic Hospital from January 2013 to December 2020. Data, subjected to quality control measures, were extracted from a well-curated secondary database. IVH diagnosis and grading were based on cranial ultrasound findings. Statistical analyses, including multiple logistic regression controlling for confounding factors, were conducted using R software. Ethical clearance was obtained from the Wits Human Research Ethics Council (HREC), clearance number M210962. Results Our study reveals a concerning upward trend in IVH incidence, affecting 36.7% (772/2102) of the included neonates (figure 1). Among these, males constituted 51.3% (396/772) and females 48.7% (376/772). Grade 2 IVH was the most prevalent, recorded in 16% (336/2102) of cases. Very Low Birth Weight (VLBW) and Extremely Low Birth Weight (ELBW) neonates comprised 57.4% (443/772) and 42.6% (329/772) of IVH instances, respectively. Neonates born between 28–31 weeks of gestational age had the highest occurrence of IVH, at 55.2% (426/772). Of the neonates who died in the hospital, 39.1% (302/772) were diagnosed with IVH. Multiple logistic regression identified significant associations between IVH and ELBW (aOR 1.5, 95% CI 1.19–2.0, p<0.001), gestational age <28 weeks (aOR 1.5, 95% CI 1.13–1.92, p<0.001), vaginal delivery (aOR 1.68, 95%CI 1.31–2.17, p<0.001), an APGAR score of 0–5 at 5 minutes (aOR 1.7, 95% CI 1.56–2.55, p<0.001), late-onset sepsis (aOR 1.35, 95% CI 1.07–1.71, p<0.001), facemask ventilation (aOR 1.48, 95% CI 1.14–1.91, p<0.001), and conventional ventilation (aOR 2.85, 95% CI 2.23–3.62, p<0.001) (figure 2). Conclusion The study identifies several factors significantly associated with IVH in neonates, including ELBW, low gestational age, vaginal delivery, poor Apgar scores, late-onset sepsis, and specific ventilation methods. These findings suggest immediate avenues for targeted neonatal care interventions. Future prospective studies are needed to confirm these findings and to develop preventive strategies. References Roberts JC, Javed MJ, Hocker JR, Wang H, Tarantino MD. Risk factors associated with intraventricular hemorrhage in extremely premature neonates. Blood Coagul Fibrinolysis. 2018 Jan;29(1):25–29. doi: 10.1097/MBC.0000000000000661. PMID: 28901997. MacLeod R, Paulson JN, Okalany N, Okello F, Acom L, Ikiror J, Cowan FM, Tann CJ, Dyet LE, Hagmann CF, Burgoine K. Intraventricular haemorrhage in a Ugandan cohort of low-birth-weight neonates: the IVHU study. BMC Pediatr. 2021 Jan 6;21(1):12. doi: 10.1186/s12887-020-02464-4. PMID: 33407279; PMCID: PMC7786968. Egwu CC, Ogala WN, Farouk ZL, Tabari AM, Dambatta AH. Factors associated with intraventricular hemorrhage among preterm neonates in aminu kano teaching hospital. Nigerian Journal of Clinical Practice. March 2019;22(3):298–304, | DOI: 10.4103/njcp.njcp_154_18.