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The Prevalence of Intraventricular Haemorrhage and Associated Risk Factors in Preterm Neonates in the Neonatal Intensive Care Unit at the University Teaching Hospital, Lusaka, Zambia
Abstract
Objectives: The study was undertaken with the aims of determining the prevalence and most frequent grade of IVH as well as associated risk factors in preterm neonates with birth weight 1.5kg or less admitted to the neonatal intensive care unit at the UTH in Lusaka, Zambia
Design: This was a cross sectional study where 298 preterm neonates meeting the study's inclusion criteria had cranial ultrasound done in the first three days of life and on the seventh postnatal day. Data on the risk factors was obtained from the neonatal referral form, maternal records and direct interview with the neonate's mother.
Main outcomes and Measures: The main outcomes were the prevalence of IVH and the most frequent grade of IVH. The variable any-IVH generated at the time of analysis was used in determining the prevalence of IVH and also as the dependent variable in multivariate logistic regression. Any-IVH was the highest grade of IVH obtained on either the first 3 days or day 7 on cranial ultrasound.
Results: In this study, the prevalence of intraventricular haemorrhage in preterm infants with birth weight 1.5kg and less was 34.2% in the first seven days of postnatal life. Grade 1 (mild) IVH was the most frequent (54.9%) followed by severe IVH (grade 3 and 4) at 27.5%. The case fatality rate was 85.7% for those with grade 4 in the first three days of life. Grade 2 was the least prevalent at 17.7%. Risk factors significantly associated with IVH were birth weight [p=0.04, OR= 0.25(0.06-0.98) 95% C.I.] and gestational age [p=0.02, OR= 0.82 (0.69-0.97) 95%C.I.]
Conclusions: The study found a similar or even lower overall prevalence to that reported in studies in Africa and globally, while the frequency of severe IVH was relatively very high with a high case fatality rate (85.7%) in the first seven days of postnatal life in respect of grade 4 IVH. Risk factors significantly associated with IVH were birth weight and gestational age while the former was also significantly associated with severe IVH as in other
studies internationally.
Design: This was a cross sectional study where 298 preterm neonates meeting the study's inclusion criteria had cranial ultrasound done in the first three days of life and on the seventh postnatal day. Data on the risk factors was obtained from the neonatal referral form, maternal records and direct interview with the neonate's mother.
Main outcomes and Measures: The main outcomes were the prevalence of IVH and the most frequent grade of IVH. The variable any-IVH generated at the time of analysis was used in determining the prevalence of IVH and also as the dependent variable in multivariate logistic regression. Any-IVH was the highest grade of IVH obtained on either the first 3 days or day 7 on cranial ultrasound.
Results: In this study, the prevalence of intraventricular haemorrhage in preterm infants with birth weight 1.5kg and less was 34.2% in the first seven days of postnatal life. Grade 1 (mild) IVH was the most frequent (54.9%) followed by severe IVH (grade 3 and 4) at 27.5%. The case fatality rate was 85.7% for those with grade 4 in the first three days of life. Grade 2 was the least prevalent at 17.7%. Risk factors significantly associated with IVH were birth weight [p=0.04, OR= 0.25(0.06-0.98) 95% C.I.] and gestational age [p=0.02, OR= 0.82 (0.69-0.97) 95%C.I.]
Conclusions: The study found a similar or even lower overall prevalence to that reported in studies in Africa and globally, while the frequency of severe IVH was relatively very high with a high case fatality rate (85.7%) in the first seven days of postnatal life in respect of grade 4 IVH. Risk factors significantly associated with IVH were birth weight and gestational age while the former was also significantly associated with severe IVH as in other
studies internationally.
