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Arch Dis Child Fetal Neonatal Ed. 2019 Jun 14. pii: fetalneonatal-2018-316664. doi: 10.1136/archdischild-2018-316664. [Epub ahead of print]

Improving incidence trends of severe intraventricular haemorrhages in preterm infants <32 weeks gestation: a cohort study.

Author information

1
Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia.
2
Department of Neonatology, KK Women's and Children's Hospital, Singapore.
3
Mount Gambier Hospital, Mount Gambier, South Australia, Australia.
4
National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.
5
School of Women's & Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
6
Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
7
National Health & Medical Research Council Trials Centre, University of Sydney, Sydney, New South Wales, Australia.

Abstract

OBJECTIVE:

To describe the trend and risk factors for severe intraventricular haemorrhage (IVH) among infants <32 weeks gestation.

DESIGN:

Population-based cohort study.

SETTING:

Australia and New Zealand.

PATIENTS:

All preterm infants <32 weeks gestation in the Australian and New Zealand Neonatal Network (ANZNN) from 1995 to 2012.

INTERVENTIONS:

Comparison of IVH incidence between 6-year epochs.

MAIN OUTCOME MEASURES:

Overall IVH and severe IVH incidence.

RESULTS:

A total of 60 068 infants were included, and overall survival to discharge increased from 89% to 93% over the three epochs. As the percentage of infants with IVH decreased from 23.6% to 21.3% and 21.4% (p<0.001) from epoch 1 to 3, respectively, fewer survivors had severe IVH (4.0%, 3.3% and 2.8%, respectively, p<0.001). Over time, there were fewer antenatal complications, higher antenatal steroid usage and more caesarean-section births. Fewer infants were intubated at birth, had low 5 min Apgar score, had sepsis or pneumothorax needing drainage. Adjusted for perinatal confounders, there was significant reduction in odds of severe IVH from epoch 1 to 3 (adjusted OR (AOR) 0.8, 95% CI 0.7 to 0.9). Factors associated with development of severe IVH include no antenatal steroids (AOR 1.7, 95% CI 1.5 to 1.9), male (AOR 1.3, 95% CI 1.2 to 1.4), 5 min Apgar score <7 (AOR 2.0, 95% CI 1.9 to 2.2), intubated at birth (AOR 2.0, 95% CI 1.8 to 2.2), extremely low gestational age (AOR 4.0, 95% CI 3.7 to 4.4), outborn (AOR 1.6, 95% CI 1.5 to 1.8) and vaginal delivery (AOR 1.4, 95% CI 1.3 to 1.6).

CONCLUSIONS:

Along with increased survival among infants born <32 weeks gestation, the incidence of severe IVH has decreased over the 18 years, especially in the most recent period. This coincided with reduction in rates of risk factors for severe IVH development.

KEYWORDS:

epidemiology; neonatology

Conflict of interest statement

Competing interests: None declared.

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