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Childs Nerv Syst. 2018 Nov;34(11):2203-2213. doi: 10.1007/s00381-018-3897-4. Epub 2018 Jul 9.

Predictors of mortality for preterm infants with intraventricular hemorrhage: a population-based study.

Author information

1
Department of Neurological Surgery, Washington University School of Medicine, One Children's Place, Suite 4S20, St. Louis Children's Hospital, St. Louis, MO, 63110, USA. rowland.han@wustl.edu.
2
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
3
Department of Neurological Surgery, Washington University School of Medicine, One Children's Place, Suite 4S20, St. Louis Children's Hospital, St. Louis, MO, 63110, USA.
4
Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
5
Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
6
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
7
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.

Abstract

PURPOSE:

The goal of this longitudinal, population-level study was to examine factors affecting mortality in preterm infants with intraventricular hemorrhage (IVH).

METHODS:

The study examined patients who were born at 36 weeks estimated gestational age (EGA) or less with a diagnosis of IVH between the years 2005 and 2014 using data from the New York and Nebraska State Inpatient Databases. Potential predictors for mortality were investigated with multivariable survival analysis.

RESULTS:

The cohort included 7437 preterm infants with IVH. All-cause inpatient mortality occurred in 746 (10.0%). The majority of deaths were in infants born at less than 25 weeks EGA (378 or 50.7%) and with birthweight less than 750 g (459 or 61.5%). Mortality was highest for children with grade IV IVH (306/848 or 36.1%), followed by grades III (203/955 or 21.3%), II (103/1328 or 7.8%), and I (134/4306 or 3.1%). Hydrocephalus was diagnosed within 6 months in 627 (8.4%) patients, with cerebrospinal fluid shunts required in 237 (3.2%). Shunts were eventually revised in 122 (51.5% of shunts), and 43 (18.1%) had infections. Multivariable Cox survival analyses found male sex (HR 1.3 [95% CI 1.1-1.5]), Asian race (HR 1.5 [1.1-2.2]), lower EGA (HR 9.9 [6.3-15.5] for < 25 weeks), higher IVH grade (HR 6.1 [4.9-7.6] for grade IV), gastrostomy (HR 4.0 [2.0-7.7]), tracheostomy (HR 3.5 [1.7-7.1]), and shunt infection (HR 3.2 [1.0-9.9]) to be independently associated with increased mortality risk.

CONCLUSIONS:

This database is the first of its kind assembled for population-based investigations of long-term neurosurgical outcomes in preterm infants with IVH.

KEYWORDS:

ICD-9-CM; Preterm neonates; State inpatient databases; Survival analysis

PMID:
29987373
PMCID:
PMC6326904
[Available on 2019-11-01]
DOI:
10.1007/s00381-018-3897-4

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