Reducing risk factors and intraventricular haemorrhage in extremely preterm infants.

Abstract

Background: Infants born <26 weeks' gestation are of greatest risk of intraventricular haemorrhage (IVH). Local grade 3/4 IVH rates at Monash Newborn in this population increased from 24.3% to 39.3% between 2020 and 2021. The ' Preterm Brain Injury Prevention Bundle ' was implemented to minimise risks for IVH. Subsequent IVH rates decreased to 12.5% in 2022 (until 31-October). We sought to identify risk factors for IVH that contributed to this trend. Method(s): Clinical parameters related to risks for IVH in the first 7 postnatal days were compared between infants born <26 weeks in 2020 and 2021 with no/mild IVH ( n = 45) and those with grade 3/4 IVH ( n = 20). Trends for improvement in IVH rate over time was assessed by comparison between infants with no/mild IVH in 2020/2021 and all infants born <26 weeks to date in 2022 ( n = 16). Chi-square, unpaired t -tests and Mann-Whitney tests were used for proportions, parametric and non-parametric data, respectively. Result(s): Infants with grade 3/4 IVH were less likely to have received antenatal steroids, had significantly lower nadirs and higher peaks in CO2 levels, greater FiO2 requirements, higher rates of pulmonary haemorrhage, more frequent use of high frequency oscillatory ventilation, more prolonged and severe metabolic acidosis, and greater use of sodium bicarbonate. Infants born to date in 2022 did not significantly differ from infants with no/mild IVH in 2020/2021, except for proportion of antenatal steroid administration. Conclusion(s): Multiple risk factors for IVH were identified. More favourable clinical parameter profiles may have contributed to the reduced IVH rate in 2022.