Intraventricular hemorrhage among very low birth weight infants in a South African cohort: a retrospective study of trends & short-term outcomes

Intraventricular hemorrhage (IVH) is one of the critical complications of prematurity with severe forms, associated with irreversible brain damage. We hypothesized that infants born in South Africa may have different modifiable risk factors and outcomes for severe IVH compared to that reported in studies in neonatal populations in higher resource settings. Our study aimed to define the prevalence of IVH with further characterization of risk factors based on IVH severity, with the goal of providing guidance on modification of protocols for the management and prevention of severe IVH. This was a retrospective cohort study of very low birth weight infants admitted to the NICU of Charlotte Maxeke Academic Hospital in Johannesburg (CMJAH) from January 1, 2016, to December 31, 2020. Our study included all infants, weighing less than 1500 g, admitted to the hospital regardless of place of birth who had had at least one cranial ultrasound in the first week of life. Infants with other intracranial malformations than IVH, birth weights greater than 1500 g, and significant amount of missing data were excluded from the study. Maternal and neonatal information were extracted from an existing neonatal database and analyzed using R statistical software. Multivariable logistic regressions were used to investigate risk factors associated with increased odds of having IVH and its impact on mortality. A total of 2,217 very low birthweight (VLBW) infants admitted to the NICU at CMJAH during the study period met eligibility criteria. Median gestational age (GA) and birth weight (BW) were 28 weeks and 900 g, respectively. IVH prevalence was 22.6% with high grade IVH (grade 3 or 4) accounting for 6.8% of the cases. Infants with high grade IVH had 4-fold increase odds of dying (OR = 4.843, 95% CI = 2.984; 7.86, p < 0.001). Acidosis was associated with increased odds of high grade IVH (OR = 2.27; 95%CI: 1.42; 3.64). Similarly, infants with early onset sepsis had higher odds of high grade IVH (OR = 2.22; 95%CI: 1.04; 4.75). Acidosis and sepsis had a significant association with the occurrence of severe IVH. Antenatal steroids showed an association with occurrence and severity suggesting it may play an important role, but did not reach significance so must be further evaluated. Having severe IVH substantially increased the odds of death. Based on these findings, future directions could include collaborative QI projects with obstetricians to improve uptake of antenatal steroids and promotion of neonatology led QI projects to reduce risk factors associated with severe IVH.