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Klin Padiatr 2016; 228(05): 245-250
DOI: 10.1055/s-0042-111689
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Risk Factors Associated with Intraventricular Hemorrhage in Preterm Infants with ≤28 Weeks Gestational Age

Risikofaktoren assoziiert mit intraventrikulärer Hirnblutung bei Frühgeborenen mit einem Gestationsalter≤28 Schwangerschaftswochen
M. Waitz
1   Division of Neonatology, Department of Pediatrics and Adolescent Medicine, University Gießen, Germany
,
S. Nusser
2   Division of Neonatology and Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, University Ulm, Germany
,
M. B. Schmid
2   Division of Neonatology and Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, University Ulm, Germany
,
J. Dreyhaupt
3   Institute of Epidemiology and Medical Biometry, Universitat Ulm, Ulm, Germany
,
F. Reister
4   Department of Obstetrics and Gynecology, Universitat Ulm, Ulm, Germany
,
H. Hummler
2   Division of Neonatology and Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, University Ulm, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
12 September 2016 (online)

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Abstract

Objective: To identify obstetric and neonatal risk factors associated with the development of germinal matrix-intraventricular hemorrhage (GM-IVH) in high-risk preterm neonates.

Methods and Patients: Data from 279 preterm infants (246 mothers) with a gestational age≤28+0 weeks admitted to our NICU between January 2004 and December 2009 were analyzed retrospectively. Occurrence of (GM-IVH) was diagnosed by using ultrasound and important clinical variables were extracted from the patient charts. Infants were divided into 2 groups: GM-IVH and non-GM-IVH. To account for multiple gestation, generalized estimation equations (GEE) were used for univariate analysis and for the evaluation of independent risk factors.

Results: A low 5-min APGAR-Score, multiple birth, low arterial blood pressure at NICU admission, hypercapnia during the first 72 h of life in life and absence of any antenatal corticosteroids were found to be significant independent risk factors in the development of GM-IVH.

Conclusion: Preterm infants with low arterial blood pressure, absence of antenatal corticosteroids, low 5-min APGAR-Score, higher paCO2 within the first 3 days of life and multiple gestation were at higher risk to develop GM-IVH. Avoiding these risk factors may help to decrease the rate of GM-IVH.

Zusammenfassung

Ziel: Identifikation von geburtshilflichen und neonatalen Risikofaktoren die mit der Entwicklung einer intraventrikulären Hirnblutung bei Hochrisiko-Frühgeborenen assoziiert sein können.

Methodik und Patienten: Es erfolgte ein retrospektive Datenanalyse von 279 Frühgeborenen (246 Mütter) mit einem Gestationsalter von ≤28+0 Schwangerschaftswochen, die in unserem Perinatalzentrum zwischen Januar 2004 und Dezember 2009 behandelt wurden. Die Diagnosesicherung und Graduierung einer GM-IVH erfolgte sonografisch. Wichtige klinische Variablen wurden aus den Patientenakten entnommen und die Einteilung der Kinder erfolgte in 2 Gruppen: GM-IVH-Gruppe und Nicht-GM-IVH-Gruppe. Für die univariate Analyse wurden wegen der Mehrfachgeburten verallgemeinerte Schätzgleichungen (GEE) verwendet, ebenso zur Identifikation von unabhängigen Risikofaktoren.

Ergebnisse: Ein niedriger 5-min-APGAR-Wert, Mehrgeburtlichkeit, niedriger systemarterieller Blutdruck, höhere paCO2-Werte innerhalb der ersten 72 Lebensstunden und fehlende Lungenreifungsbehandlung waren unabhängige Risikofaktoren die mit der Entwicklung einer intraventrikulären Blutung assoziiert waren.

Schlussfolgerung: Frühgeborene mit einem niedrigeren arteriellen Blutdruck, fehlende Lungenreifungsbehandlung der Mutter, ein niedriger 5-min-APGAR-Wert, Hyperkapnie während der ersten 3 Lebenstage hatten ein höheres Risiko für die Entwicklung einer GM-IVH. Die Vermeidung dieser Risikofaktoren könnte die Rate an Hirnblutungen bei Risikofrühgeborenen reduzieren.

Key words

risk factors - intraventricular haemorrhage - preterm infants - prevention

Schlüsselwörter

Risikofaktoren - Intraventrikuläre Blutung - Frühgeborene - Prävention
 

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