Abstract
Purpose: Advancements in neonatal care have increased the survival rates of premature infants, but intracranial hemorrhage (ICH) continues to be a concerning issue in neonatal intensive care units (NICU). This study sought to evaluate the risk factors associated with ICH in preterm infants born before 29 weeks of gestation, with a particular focus on the preventive measures.
Materials and methods: In a perinatology center with a 61-bed level-4 unit, this retrospective cohort study was conducted in the neonatal intensive care unit. Digital hospital records were scanned for infants born ≤290/7 weeks and hospitalized between 2021-2023. We categorized the study population into three groups based on the increasing severity of ICH according to the first week transfontanelle ultrasonography findings. Demographic, perinatal characteristics, cord blood gas values, platelet count, platelet mass were recorded as laboratory parameters. Clinical interventions, follow-up data and transfusion of blood products, mechanical ventilation requirements, inotrope use within the first 72 hours, length of hospital stay, mortality data were recorded.
Results: A total of 96 patients(female/male:39/57) were enrolled in the study. A significant difference in mean gestational age was observed among patients in Group-1 (no-ICH, n=50), Group-2 (mild, n=25), and Group-3 (severe, n=21) (p<0.001). Additionally, antenatal corticosteroid therapy was notably less frequent in Groups-2 and 3 (p=0.044). Cord lactate and the rate of metabolic acidosis were significantly higher in Group-3 (p=0.026, <0.001). The platelet count and platelet mass were significantly lower in Group3 compared to the other two groups (p=0.014, p=0.023).
Conclusion: Our findings emphasize reduced antenatal corticosteroid use, higher metabolic acidosis rates, increased transfusion needs, and lower platelet mass as prominent risk factors, reaffirming the multifactorial nature of ICH. We believe these measures can be integrated into clinical protocols within the framework of an ''ICH prevention bundle''.
References
- Bassan H. Intracranial hemorrhage in the preterm infant: understanding it, preventing it. Clin Perinatol. 2009;36(4):737-v. doi:10.1016/j.clp.2009.07.014
- Coskun Y, Isik S, Bayram T, Urgun K, Sakarya S, Akman I. A clinical scoring system to predict the development of intraventricular hemorrhage (IVH) in premature infants. Childs Nerv Syst. 2018;34(1):129-136. doi:10.1007/s00381-017-3610-z
- Depala KS, Chintala S, Joshi S, et al. Clinical Variables Associated With Grade III and IV Intraventricular Hemorrhage (IVH) in Preterm Infants Weighing Less Than 750 Grams. Cureus. 2023;15(6):e40471. doi:10.7759/cureus.40471
- Ding R, Zhang Q, Duan Y, Wang D, Sun Q, Shan R. The relationship between platelet indices and patent ductus arteriosus in preterm infants: a systematic review and meta-analysis. Eur J Pediatr. 2021;180(3):699-708. doi:10.1007/s00431-020-03802-5
- Jain A, Shah PS. Diagnosis, Evaluation, and Management of Patent Ductus Arteriosus in Preterm Neonates. JAMA Pediatr. 2015;169(9):863-872. doi:10.1001/jamapediatrics.2015.0987
- Zhong J, Lin B, Fu Y, et al. Platelet Count Might Be Associated With the Closure of Hemodynamically Significant Patent Ductus Arteriosus. Front Pediatr. 2021;9:729461. doi:10.3389/fped.2021.729461
- Dani C, Ciarcià M, Miselli F, et al. Platelet Count and Volume and Pharmacological Closure with Paracetamol of Ductus Arteriosus in Preterm Infants. Children (Basel). 2022;9(1):89. doi:10.3390/children9010089
- Çizmeci MN, Akın MA, Özek E. Türk Neonatoloj Derneği germinal matriks kanaması-intraventrküler kanama ve komplikasyonlarının tanı ve yönetimi rehberi 2021.
- Inder TE Perlman JM, Volpe JJ. Preterm Intraventricular Hemorrhage/Posthemorrhagic Hydrocephalus. In: Volpe’s Neurology of the Newborn, 6th, Volpe JJ (Ed), Elsevier, Philadelphia 2018:637-98.
- Okur N, Buyuktiryaki M, Uras N, et al. Platelet mass index in very preterm infants: can it be used as a parameter for neonatal morbidities?. J Matern Fetal Neonatal Med. 2016;29(19):3218-3222. doi:10.3109/14767058.2015.1121475
- Itsiakos G, Papathanasiou AE, Kyriakidis I, et al. Intraventricular Hemorrhage and Platelet Indices in Extremely Premature Neonates. J Pediatr Hematol Oncol. 2016;38(7):533-538. doi:10.1097/MPH.0000000000000631
- Zisk JL, Mackley A, Christensen RD, Paul DA. Is a small platelet mass associated with intraventricular hemorrhage in very low-birth-weight infants?. J Perinatol. 2011;31(12):776-779. doi:10.1038/jp.2011.32
- Korkmaz L, Bastug O, Ozdemir A, et al. Can Platelet Mass Index Be a Parameter to Predict Intraventricular Hemorrhage in Very-Low-Birth-Weight Newborns?. Am J Perinatol. 2019;36(11):1188-1197. doi:10.1055/s-0038-1676535
- Chen C, Wu S, Chen J, et al. Evaluation of the Association of Platelet Count, Mean Platelet Volume, and Platelet Transfusion With Intraventricular Hemorrhage and Death Among Preterm Infants. JAMA Netw Open. 2022;5(10):e2237588. doi:10.1001/jamanetworkopen.2022.37588
- Calisici E, Eras Z, Oncel MY, Oguz SS, Gokce İK, Dilmen U. Neurodevelopmental outcomes of premature infants with severe intraventricular hemorrhage. J Matern Fetal Neonatal Med. 2015;28(17):2115-2120. doi:10.3109/14767058.2014.979783
- Obladen M, Metze B, Henrich W, Aktas A, Czernik C, Schulz-Baldes A. Interdisciplinary surveillance of intraventricular haemorrhage associated conditions in infants <1000 g. Acta Paediatr. 2008;97(6):731-737. doi:10.1111/j.1651-2227.2008.00812.x
- Stoll BJ, Hansen NI, Bell EF, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics. 2010;126(3):443-456. doi:10.1542/peds.2009-2959
- Odd D, Reeve NF, Barnett J, et al. PRECIOUS study (PREterm Caesarean/vaginal birth and IVH/OUtcomeS): does mode of birth reduce the risk of death or brain injury in very preterm babies? A cohort and emulated target trial protocol. BMJ Open. 2024;14(9):e089722. doi:10.1136/bmjopen-2024-089722
- Jang HG, Choi S, Noh OK, Hwang JH, Lee JH; Korean Neonatal Network. Comparison of neonatal outcomes between multiples and singletons among very low birth weight infants: the Korean Neonatal Network cohort study. J Matern Fetal Neonatal Med. 2023;36(2):2245530. doi:10.1080/14767058.2023.2245530
- Lee R, Williams EE, Dassios T, Greenough A. Influence of antenatal corticosteroids and sex on the mortality and morbidity of extremely prematurely born infants. J Matern Fetal Neonatal Med. 2022;35(25):8062-8065. doi:10.1080/14767058.2021.1940941
- Lee JY, Kim HS, Jung E, et al. Risk factors for periventricular-intraventricular hemorrhage in premature infants. J Korean Med Sci. 2010;25(3):418-424. doi:10.3346/jkms.2010.25.3.418
- Genzel-Boroviczény O, MacWilliams S, Von Poblotzki M, Zoppelli L. Mortality and major morbidity in premature infants less than 31 weeks gestational age in the decade after introduction of surfactant. Acta Obstet Gynecol Scand. 2006;85(1):68-73. doi:10.1080/00016340500290947
- Cimatti AG, Martini S, Galletti S, et al. Cerebral Oxygenation and Autoregulation in Very Preterm Infants Developing IVH During the Transitional Period: A Pilot Study. Front Pediatr. 2020;8:381. doi:10.3389/fped.2020.00381
- Wang Y, Yang Y, Wen L, Li M. Risk factors and nomogram for the prediction of intracranial hemorrhage in very preterm infants. BMC Pediatr. 2024;24(1):793. doi:10.1186/s12887-024-05274-0
- Schmid MB, Reister F, Mayer B, Hopfner RJ, Fuchs H, Hummler HD. Prospective risk factor monitoring reduces intracranial hemorrhage rates in preterm infants. Dtsch Arztebl Int. 2013;110(29-30):489-496. doi:10.3238/arztebl.2013.0489
- Kolnik SE, Upadhyay K, Wood TR, Juul SE, Valentine GC. Reducing Severe Intraventricular Hemorrhage in Preterm Infants With Improved Care Bundle Adherence. Pediatrics. 2023;152(3):e2021056104. doi:10.1542/peds.2021-056104
Abstract
Amaç: Yenidoğan bakımındaki ilerlemeler prematüre bebeklerin hayatta kalma oranlarını artırmış olsa da yenidoğan yoğun bakım ünitelerinde (YYBÜ) görülen intrakraniyal kanama (iKK) önemli bir sorun olmaya devam etmektedir. Bu çalışmada, 29. gebelik haftasından önce doğan prematüre bebeklerde İKK risk faktörlerini değerlendirmeyi, önleyici stratejileri öne çıkarmayı amaçladık.
Gereç ve yöntem: Bu retrospektif kohort çalışması, perinatoloji merkezinde bulunan 61 yatak kapasiteli, 4.seviye YYBÜ'de yürütülmüştür. Dijital hastane kayıtları, ≤290/7 gebelik haftasında doğan ve 2021-2023 yılları arasında hastaneye yatırılan bebekler için tarandı. Çalışma popülasyonu, ilk hafta yapılan transfontanel ultrasonografi bulgularına göre İKK'nın giderek artan şiddetine dayanarak üç gruba ayrıldı. Demografik ve perinatal özellikler ile birlikte, kordon kan gaz değerleri, platelet sayısı, platelet kütlesi laboratuvar parametreleri kapsamında kaydedildi. Klinik müdahaleler, takip verileri, kan ürünü transfüzyonu, mekanik ventilasyon gereklilikleri, ilk 72 saat içinde inotrop kullanımı, hastanede kalış süresi ve ölüm oranı gibi bilgiler analiz edildi.
Bulgular: Çalışmaya 96 hasta (kadın/erkek:39/57) dahil edildi. Gebelik haftası ortalamaları açısından Grup1 (İKK olmayan, n=50), Grup2 (hafif İKK, n=25) ve Grup3 (şiddetli İKK, n=21) arasında istatistiksel olarak anlamlı bir fark bulundu (p<0.001). Ayrıca, Grup2 ve Grup3’te antenatal kortikosteroid tedavisinin uygulanma oranı anlamlı derecede daha düşüktü (p=0.044). Kordon laktatı ve metabolik asidoz oranı Grup3'te anlamlı derecede yüksekti (p=0.026, <0.001). Trombosit sayısı ve trombosit kütlesi değerleri Grup3'te diğer iki gruba kıyasla belirgin şekilde daha düşük çıktı (p=0.014, p=0.023).
Tartışma: Bulgularımız, azalmış antenatal kortikosteroid kullanımı, yüksek metabolik asidoz oranları, artan transfüzyon ihtiyaçları, düşük trombosit kütlesi gibi önemli risk faktörlerini vurgulamakta, İKK'nın çok faktörlü yapısını yeniden doğrulamaktadır. Bu bulguların "İKK önleme paketi" çerçevesinde klinik protokollere entegre edilebileceğini düşünüyoruz.
References
- Bassan H. Intracranial hemorrhage in the preterm infant: understanding it, preventing it. Clin Perinatol. 2009;36(4):737-v. doi:10.1016/j.clp.2009.07.014
- Coskun Y, Isik S, Bayram T, Urgun K, Sakarya S, Akman I. A clinical scoring system to predict the development of intraventricular hemorrhage (IVH) in premature infants. Childs Nerv Syst. 2018;34(1):129-136. doi:10.1007/s00381-017-3610-z
- Depala KS, Chintala S, Joshi S, et al. Clinical Variables Associated With Grade III and IV Intraventricular Hemorrhage (IVH) in Preterm Infants Weighing Less Than 750 Grams. Cureus. 2023;15(6):e40471. doi:10.7759/cureus.40471
- Ding R, Zhang Q, Duan Y, Wang D, Sun Q, Shan R. The relationship between platelet indices and patent ductus arteriosus in preterm infants: a systematic review and meta-analysis. Eur J Pediatr. 2021;180(3):699-708. doi:10.1007/s00431-020-03802-5
- Jain A, Shah PS. Diagnosis, Evaluation, and Management of Patent Ductus Arteriosus in Preterm Neonates. JAMA Pediatr. 2015;169(9):863-872. doi:10.1001/jamapediatrics.2015.0987
- Zhong J, Lin B, Fu Y, et al. Platelet Count Might Be Associated With the Closure of Hemodynamically Significant Patent Ductus Arteriosus. Front Pediatr. 2021;9:729461. doi:10.3389/fped.2021.729461
- Dani C, Ciarcià M, Miselli F, et al. Platelet Count and Volume and Pharmacological Closure with Paracetamol of Ductus Arteriosus in Preterm Infants. Children (Basel). 2022;9(1):89. doi:10.3390/children9010089
- Çizmeci MN, Akın MA, Özek E. Türk Neonatoloj Derneği germinal matriks kanaması-intraventrküler kanama ve komplikasyonlarının tanı ve yönetimi rehberi 2021.
- Inder TE Perlman JM, Volpe JJ. Preterm Intraventricular Hemorrhage/Posthemorrhagic Hydrocephalus. In: Volpe’s Neurology of the Newborn, 6th, Volpe JJ (Ed), Elsevier, Philadelphia 2018:637-98.
- Okur N, Buyuktiryaki M, Uras N, et al. Platelet mass index in very preterm infants: can it be used as a parameter for neonatal morbidities?. J Matern Fetal Neonatal Med. 2016;29(19):3218-3222. doi:10.3109/14767058.2015.1121475
- Itsiakos G, Papathanasiou AE, Kyriakidis I, et al. Intraventricular Hemorrhage and Platelet Indices in Extremely Premature Neonates. J Pediatr Hematol Oncol. 2016;38(7):533-538. doi:10.1097/MPH.0000000000000631
- Zisk JL, Mackley A, Christensen RD, Paul DA. Is a small platelet mass associated with intraventricular hemorrhage in very low-birth-weight infants?. J Perinatol. 2011;31(12):776-779. doi:10.1038/jp.2011.32
- Korkmaz L, Bastug O, Ozdemir A, et al. Can Platelet Mass Index Be a Parameter to Predict Intraventricular Hemorrhage in Very-Low-Birth-Weight Newborns?. Am J Perinatol. 2019;36(11):1188-1197. doi:10.1055/s-0038-1676535
- Chen C, Wu S, Chen J, et al. Evaluation of the Association of Platelet Count, Mean Platelet Volume, and Platelet Transfusion With Intraventricular Hemorrhage and Death Among Preterm Infants. JAMA Netw Open. 2022;5(10):e2237588. doi:10.1001/jamanetworkopen.2022.37588
- Calisici E, Eras Z, Oncel MY, Oguz SS, Gokce İK, Dilmen U. Neurodevelopmental outcomes of premature infants with severe intraventricular hemorrhage. J Matern Fetal Neonatal Med. 2015;28(17):2115-2120. doi:10.3109/14767058.2014.979783
- Obladen M, Metze B, Henrich W, Aktas A, Czernik C, Schulz-Baldes A. Interdisciplinary surveillance of intraventricular haemorrhage associated conditions in infants <1000 g. Acta Paediatr. 2008;97(6):731-737. doi:10.1111/j.1651-2227.2008.00812.x
- Stoll BJ, Hansen NI, Bell EF, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics. 2010;126(3):443-456. doi:10.1542/peds.2009-2959
- Odd D, Reeve NF, Barnett J, et al. PRECIOUS study (PREterm Caesarean/vaginal birth and IVH/OUtcomeS): does mode of birth reduce the risk of death or brain injury in very preterm babies? A cohort and emulated target trial protocol. BMJ Open. 2024;14(9):e089722. doi:10.1136/bmjopen-2024-089722
- Jang HG, Choi S, Noh OK, Hwang JH, Lee JH; Korean Neonatal Network. Comparison of neonatal outcomes between multiples and singletons among very low birth weight infants: the Korean Neonatal Network cohort study. J Matern Fetal Neonatal Med. 2023;36(2):2245530. doi:10.1080/14767058.2023.2245530
- Lee R, Williams EE, Dassios T, Greenough A. Influence of antenatal corticosteroids and sex on the mortality and morbidity of extremely prematurely born infants. J Matern Fetal Neonatal Med. 2022;35(25):8062-8065. doi:10.1080/14767058.2021.1940941
- Lee JY, Kim HS, Jung E, et al. Risk factors for periventricular-intraventricular hemorrhage in premature infants. J Korean Med Sci. 2010;25(3):418-424. doi:10.3346/jkms.2010.25.3.418
- Genzel-Boroviczény O, MacWilliams S, Von Poblotzki M, Zoppelli L. Mortality and major morbidity in premature infants less than 31 weeks gestational age in the decade after introduction of surfactant. Acta Obstet Gynecol Scand. 2006;85(1):68-73. doi:10.1080/00016340500290947
- Cimatti AG, Martini S, Galletti S, et al. Cerebral Oxygenation and Autoregulation in Very Preterm Infants Developing IVH During the Transitional Period: A Pilot Study. Front Pediatr. 2020;8:381. doi:10.3389/fped.2020.00381
- Wang Y, Yang Y, Wen L, Li M. Risk factors and nomogram for the prediction of intracranial hemorrhage in very preterm infants. BMC Pediatr. 2024;24(1):793. doi:10.1186/s12887-024-05274-0
- Schmid MB, Reister F, Mayer B, Hopfner RJ, Fuchs H, Hummler HD. Prospective risk factor monitoring reduces intracranial hemorrhage rates in preterm infants. Dtsch Arztebl Int. 2013;110(29-30):489-496. doi:10.3238/arztebl.2013.0489
- Kolnik SE, Upadhyay K, Wood TR, Juul SE, Valentine GC. Reducing Severe Intraventricular Hemorrhage in Preterm Infants With Improved Care Bundle Adherence. Pediatrics. 2023;152(3):e2021056104. doi:10.1542/peds.2021-056104
Details
| Primary Language | English |
|---|---|
| Subjects | Neonatology |
| Journal Section | Research Article |
| Authors | |
| Early Pub Date | July 3, 2025 |
| Publication Date | |
| Submission Date | May 16, 2025 |
| Acceptance Date | June 30, 2025 |
| Published in Issue | Year 2025 Volume: 18 Issue: 4 |
