Postnatal Paraclinical Parameters Associated to Occurrence of Intracerebral Hemorrhage in Preterm Infants

Abstract

Intracerebral hemorrhage (ICH) is the most frequent complication in postnatal development of preterm infants. The purpose of the present work is the statistical evaluation of seven standard paraclinical parameters and their association to the development of ICH. Clinical records of 265 preterm infants with gestational age (GA) 23 to 30 weeks were analyzed. According to ICH status, patients were divided into control (without ICH) and affected (with ICH) groups. Mean values of paraclinical parameters at each week of gestation were compared. Different ICH grades, periods before and after ICH were considered separately. Lower hematocrit, SaO₂, and pH were statistically significant for preterm infants with 23 to 30 weeks GA and diagnosis of ICH relative to infants without ICH. Additionally, for preterm infants with 27 to 30 weeks GA, higher C-reactive protein, as well as lower values of thrombocytes were associated with the occurrence of ICH. Preterm infants with 23 to 26 weeks GA showed C-reactive protein values similar to those in the group without ICH and lower levels of thrombocytes after bleeding. Significant differences in paraclinical parameters between preterm infants with and without ICH may constitute useful indicators for closer clinical observation of preterm infants at risk of ICH.

Keywords

risk factors - gestational age - statistical analysis - odds ratio

Financial Disclosure

The authors have no financial relationships relevant to this article to disclose.

• References

• 1 Gradnitzer E, Urlesberger B, Maurer U, Riccabona M, Müller W. Hirnblutung beim reifen Neugeborenen--eine Analyse von 10 Jahren (1989-1999). Wien Med Wochenschr 2002; 152 (1-2): 9-13 (Vienna Medical Weekly)
• 2 Szpecht D, Szymankiewicz M, Nowak I, Gadzinowski J. Intraventricular hemorrhage in neonates born before 32 weeks of gestation-retrospective analysis of risk factors. Childs Nerv Syst 2016; 32 (08) 1399-1404
• 3 Hambleton G, Wigglesworth JS. Origin of intraventricular haemorrhage in the preterm infant. Arch Dis Child 1976; 51 (09) 651-659
• 4 Linsell L, Malouf R, Morris J, Kurinczuk JJ, Marlow N. Prognostic factors for cerebral palsy and motor impairment in children born very preterm or very low birthweight: a systematic review. Dev Med Child Neurol 2016; 58 (06) 554-569
• 5 Soul JS, Hammer PE, Tsuji M. , et al. Fluctuating pressure-passivity is common in the cerebral circulation of sick premature infants. Pediatr Res 2007; 61 (04) 467-473
• 6 Lampe R, Botkin N, Turova V, Blumenstein T, Alves-Pinto A. Mathematical modelling of cerebral blood circulation and cerebral autoregulation: towards preventing intracranial hemorrhages in preterm newborns. Comput Math Methods Med 2014; 2014: 965275
• 7 Salzer HR, Genger H, Muhar U, Lischka A, Schatten C, Pollak A. C-reactive protein: an early marker for neonatal bacterial infection due to prolonged rupture of amniotic membranes and/or amnionitis. Acta Obstet Gynecol Scand 1987; 66 (04) 365-367
• 8 Paul DA, Leef KH, Stefano JL. Increased leukocytes in infants with intraventricular hemorrhage. Pediatr Neurol 2000; 22 (03) 194-199
• 9 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (04) 529-534
• 10 Chang M. Optimal oxygen saturation in premature infants. Korean J Pediatr 2011; 54 (09) 359-362
• 11 McClatchey K. Clinical Laboratory Medicine. Philadelphia, PA: Lippincott Williams & Wilkins; 2002: 807
• 12 Poralla C, Hertfelder HJ, Oldenburg J, Müller A, Bartmann P, Heep A. Elevated interleukin-6 concentration and alterations of the coagulation system are associated with the development of intraventricular hemorrhage in extremely preterm infants. Neonatology 2012; 102 (04) 270-275
• 13 Newnam KM. Oxygen saturation limits and evidence supporting the targets. Adv Neonatal Care 2014; 14 (06) 403-409
• 14 Sorokin Y, Romero R, Mele L. , et al. Maternal serum interleukin-6, C-reactive protein, and matrix metalloproteinase-9 concentrations as risk factors for preterm birth <32 weeks and adverse neonatal outcomes. Am J Perinatol 2010; 27 (08) 631-640
• 15 Nusser S. Retrospektive Analyse peri-und postpartaler Risikofaktoren für Hirnblutungen in einem Ulmer Kollektiv von Frühgeborenen kleiner gleich 28 Schwangerschaftswochen [Analysis of Peri-and Postpartum Risk Factors for Cerebral Hemorrhage in a Ulm Collective of Preterm Infants Less than or Equal to 28 Weeks of Gestation]. [Ph.D. dissertation]. Universität Ulm; 2015
• 16 Manroe BL, Weinberg AG, Rosenfeld CR, Browne R. The neonatal blood count in health and disease. I. Reference values for neutrophilic cells. J Pediatr 1979; 95 (01) 89-98
• 17 Lee JY, Kim HS, Jung E. , et al. Risk factors for periventricular-intraventricular hemorrhage in premature infants. J Korean Med Sci 2010; 25 (03) 418-424
• 18 Löppönen P, Qian C, Tetri S. , et al. Predictive value of C-reactive protein for the outcome after primary intracerebral hemorrhage. J Neurosurg 2014; 121 (06) 1374-1379
• 19 Levene MI, Fawer CL, Lamont RF. Risk factors in the development of intraventricular haemorrhage in the preterm neonate. Arch Dis Child 1982; 57 (06) 410-417
• 20 Rastogi S, Olmez I, Bhutada A, Rastogi D. NCI classification of thrombocytopenia in extremely preterm neonates and its association with mortality and morbidity. J Perinat Med 2011; 39 (01) 65-69
• 21 Bonifacio L, Petrova A, Nanjundaswamy S, Mehta R. Thrombocytopenia related neonatal outcome in preterms. Indian J Pediatr 2007; 74 (03) 269-274
• 22 Poryo M, Boeckh JC, Gortner L. , et al; PROGRESS study consortium and NGFN - Nationales Genomforschungsnetz Deutschland. Ante-, peri- and postnatal factors associated with intraventricular hemorrhage in very premature infants. Early Hum Dev 2018; 116: 1-8
• 23 Duppré P, Sauer H, Giannopoulou EZ. , et al. Cellular and humoral coagulation profiles and occurrence of IVH in VLBW and ELWB infants. Early Hum Dev 2015; 91 (12) 695-700
• 24 Hasmasanu MG, Bolboaca SD, Baizat MI, Drugan TC, Zaharie GC. Neonatal short-term outcomes in infants with intrauterine growth restriction. Saudi Med J 2015; 36 (08) 947-953
• 25 Granger C, Spittle AJ, Walsh J. , et al. Histologic chorioamnionitis in preterm infants: correlation with brain magnetic resonance imaging at term equivalent age. BMC Pediatr 2018; 18 (01) 63
• 26 Osmanağaoğlu MA, Ünal S, Bozkaya H. Chorioamnionitis risk and neonatal outcome in preterm premature rupture of membranes. Arch Gynecol Obstet 2005; 271 (01) 33-39
• 27 Villamor-Martinez E, Fumagalli M, Mohammed Rahim O. , et al. Chorioamnionitis is a risk factor for intraventricular hemorrhage in preterm infants: a systematic review and meta-analysis. Front Physiol 2018; 11 (09) 1253
• 28 Shankaran S, Lin A, Maller-Kesselman J. , et al; Gene Targets for Intraventricular Hemorrhage Study. Maternal race, demography, and health care disparities impact risk for intraventricular hemorrhage in preterm neonates. J Pediatr 2014; 164 (05) 1005-1011.e3
• 29 Pontello D, Ianni A, Driul L. , et al. Prenatal risk factors for intraventricular hemorrhage, neonatal death and impaired psychomotor development in very low birth weight infants. Minerva Ginecol 2008; 60 (03) 223-229
• 30 Paul DA, Kepler J, Leef KH, Siscione A, Palmer C, Stefano JL. Effect of preeclampsia on mortality, intraventricular hemorrhage, and need for mechanical ventilation in very low-birth-weight infants. Am J Perinatol 1998; 15 (06) 381-386