Etiology and Prognosis of Intracranial Hemorrhage in Premature Infants, Cohort Research

Abstract

Introduction: Despite advances in obstetric care, the prematurity rate is increasing all over the world with the use of assisted reproductive techniques. However, the survival rates of these babies have increased thanks to the developments in neonatal and perinatal care. The specific problems and complications seen in early prematurity, determine the long-term neurodevelopmental outcome. One of the most important determinants of neurodevelopmental outcome is intraventricular hemorrhage (IVH). In this study, risk factors that could cause IVH and severe IVH were investigated in premature infants. Materials and Methods: In this study, inpatient files in the neonatal intensive care unit of our hospital in a 10-year period were analyzed retrospectively. As the patient group, 40 patients with a gestational age below 37 weeks and diagnosed with IVH; the control group was selected from patients who were hospitalized on similar dates, did not have IVH, and whose body weight and gestational age were similar to the IVH group. Results: Prolonged mechanical ventilation, hypoxemia, hypercarbia and recurrent hypercarbia attacks, hypotension, recurrent surfactant need, erythrocyte transfusion, bicarbonate therapy, use of volume expander and pregnancy with assisted reproductive techniques were found to be risk factors for IVH. Mortality rate was significantly higher in IVH group and severe IVH (stage III-IV bleeding) group compared to the control group. In IVH group, periventricular leukomalacia was observed in 4 patients and hydrocephalus in 10 patients. Conclusion: IVH is a complication of prematurity that increases long-term morbidity and mortality. Use of blood transfusions, volume expanders and bicarbonate therapy which are identified as risk factors in this study should be minimized in neonatal intensive care. Since most important risk factor is prematurity, prevention of preterm birth should be main objective of medical care.