Malyas Happiness, Chirande Lulu, Salingwa Lilian, Assenga Evelyne
Department of Paediatrics and Child Health, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar Es Salaam, Tanzania.
Department of Paediatrics and Child Health, Muhimbili National Hospital, Dar Es Salaam, Tanzania.
Ital J Pediatr. 2025 Jul 8;51(1):213. doi: 10.1186/s13052-025-01927-7.
Intraventricular hemorrhage (IVH) is a serious complication of prematurity with a potential impact on morbidity and mortality particularly in very low birth weight neonates. Despite advances in neonatal care over recent years, there is no recent data regarding IVH in our setting. This study aimed to determine the proportion of IVH, its associated factors, and mortality at Muhimbili National Hospital (MNH).
A hospital-based prospective cohort study was conducted among preterm very low birth weight neonates admitted at MNH. Data was obtained from interviews, physical examination, review of maternal antenatal cards, and neonatal records. Cranial ultrasound was done on day 3 and day 7 of life to determine the presence and severity of IVH. Mortality of neonates was determined on day 7. Data were summarised using frequencies, percentages, median, and interquartile range. Chi-square and Fisher's exact were used to measure the association between categorical variables. Variables found to be significantly associated with IVH were analysed by Poisson regression. A p-value of 0.05 or less was considered statistically significant.
The proportion of VLBW neonates with IVH was 22.9% with grade 1 being the most prevalent. The majority of IVH (74.7%) occurred within the first 3 days of life. Factors found to increase the risk of IVH in the univariate analysis were gestational age, mode of delivery, respiratory distress syndrome, hypothermia, early-onset sepsis, use of inotropes, thrombocytopenia and mechanical ventilation. However, none of these factors were independent predictors of IVH in multivariate Poisson regression analysis. Mortality of VLBW neonates with IVH was significantly higher than their counterparts without IVH (RR = 2,95% CI (1.25-3.34).
IVH is common among VLBW neonates most of which occurred by day 3 of life. The risk of Mortality was two times higher among VLBW neonates with IVH compared to those without IVH. Further research should be conducted to explore predictors of mortality and long-term outcome of VLBW neonates with IVH.
脑室内出血（IVH）是早产的一种严重并发症，对发病率和死亡率有潜在影响，尤其是在极低出生体重的新生儿中。尽管近年来新生儿护理取得了进展，但在我们的研究环境中，尚无关于IVH的最新数据。本研究旨在确定姆希比利国家医院（MNH）脑室内出血的比例、相关因素及死亡率。
在MNH收治的早产极低出生体重新生儿中开展了一项基于医院的前瞻性队列研究。数据通过访谈、体格检查、查阅产妇产前卡片及新生儿记录获得。在出生第3天和第7天进行头颅超声检查，以确定脑室内出血的存在及严重程度。在出生第7天确定新生儿死亡率。数据采用频数、百分比、中位数和四分位间距进行汇总。采用卡方检验和Fisher精确检验来衡量分类变量之间的关联。通过泊松回归分析发现与脑室内出血显著相关的变量。p值小于或等于0.05被认为具有统计学意义。
极低出生体重新生儿脑室内出血的比例为22.9%，其中1级最为常见。大多数脑室内出血（74.7%）发生在出生后的前3天。单因素分析中发现增加脑室内出血风险的因素有胎龄、分娩方式、呼吸窘迫综合征、体温过低、早发性败血症、使用血管活性药物、血小板减少症和机械通气。然而，在多因素泊松回归分析中，这些因素均不是脑室内出血的独立预测因素。有脑室内出血的极低出生体重新生儿的死亡率显著高于无脑室内出血的新生儿（RR = 2，95%CI（1.25 - 3.34））。
脑室内出血在极低出生体重新生儿中很常见，大多数发生在出生后第3天。有脑室内出血的极低出生体重新生儿的死亡风险是无脑室内出血新生儿的两倍。应开展进一步研究以探索极低出生体重脑室内出血新生儿的死亡预测因素及长期预后。
