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PEDIATRICS Vol. 112 No. 1 July 2003, pp. 33-39

Hemodynamic and Antecedent Risk Factors of Early and Late Periventricular/Intraventricular Hemorrhage in Premature Infants

David A. Osborn, MM, FRACP^*, Nick Evans, MRCPCH, DM^*, Martin Kluckow, FRACP, PhD

^* Royal Prince Alfred Hospital Sydney
Royal North Shore Hospital, Sydney, NSW, and the University of Sydney, Australia

Objectives. To determine hemodynamic and antecedent risk factors for early and late periventricular/intraventricular hemorrhage (P/IVH) in premature infants.

Methods. Two prospective cohort studies of 126 (1995–1996) and 128 (1998–1999) infants born <30 weeks’ gestation. Head ultrasounds were performed at <6 hours of age, and at 7 and 28 days of age. P/IVH was classified as early (present on initial scan) and late (developed subsequently). Echocardiographic measurement of the superior vena cava (SVC) flow was performed at <6, 10, and 24 hours of age.

Results. Infants with early P/IVH were significantly more likely to be born by vaginal delivery in both cohorts (1995–1996 adjusted odds ratios [OR]: 13.29; 1998–1999 adjusted OR: 18.15). An association with a 1-minute Apgar 4 was only significant in the 1998–1999 cohort (adjusted OR: 9.14). Low SVC flow was the only independent risk factor for late P/IVH in both cohorts (1995–1996 adjusted OR: 20.39; 1998–1999 adjusted OR: 5.16). Adjusted for perinatal risk factors, low SVC flow was associated with lower gestation and higher average mean airway pressure in both cohorts, and with a large diameter ductus diameter only in the 1995–1996 cohort.

Conclusions. Early and late P/IVH have distinct and different risk factors. Early P/IVH is associated with vaginal delivery and possibly low Apgar scores. Late P/IVH is associated with antecedent low SVC flow in the first day.

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Key Words: premature infant • regional blood flow • superior vena cava • intraventricular hemorrhage • echocardiography

Abbreviations: P/IVH, peri/intraventricular hemorrhage • DA, ductus arteriosus • SVC, superior vena cava • MAP, mean airway pressure • RDS, respiratory distress syndrome • OR, odds ratio • CI, 95% confidence interval

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Received for publication Jul 1, 2002; Accepted Nov 27, 2002.

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