Antepartum Hemorrhage and Outcome of Very Low Birth Weight, Very Preterm Infants: A Population-Based Study

Abstract

Objective We aimed to determine the independent effect of maternal antepartum hemorrhage (APH) on mortality and major neonatal morbidities among very low birth weight (VLBW), very preterm infants.

Study Design A population-based cohort study of VLBW singleton infants born at 24 to 31 weeks of gestation between 1995 and 2016 was performed. Infants born with the following pregnancy associated complications were excluded: maternal hypertensive disorders, prolonged rupture of membranes, amnionitis, maternal diabetes, and small for gestational age. APH included hemorrhage due to either placenta previa or placental abruption. Univariate and multivariable logistic regression analyses were performed to assess the effect of maternal APH on mortality and major neonatal morbidities.

Results The initial cohort included 33,627 VLBW infants. Following exclusions, the final study population comprised 6,235 infants of whom 2,006 (32.2%) were born following APH and 4,229 (67.8%) without APH. In the APH versus no APH group, there were higher rates of extreme prematurity (24–27 weeks of gestation; 51.6% vs. 45.3%, p < 0.0001), mortality (20.2 vs. 18.5%, p = 0.011), bronchopulmonary dysplasia (BPD, 16.1 vs. 13.0%, p = 0.004) and death or adverse neurologic outcome (37.4 vs. 34.5%, p = 0.03). In the multivariable analyses, APH was associated with significantly increased odds ratio (OR) for BPD in the extremely preterm infants (OR: 1.31, 95% confidence interval: 1.05–1.65). The OR's for mortality, adverse neurological outcomes, and death or adverse neurological outcome were not significantly increased in the APH group.

Conclusion Among singleton, very preterm VLBW infants, maternal APH was associated with increased odds for BPD only in extremely premature infants, but was not associated with excess mortality or adverse neonatal neurological outcomes.

Key Points

• Outcome of very low birth weight infants born after antepartum hemorrhage (APH) was assessed.

• APH was not associated with higher infant mortality.

• APH was not associated with adverse neurological outcome.

• APH was associated with increased bronchopulmonary dysplasia in extremely preterm infants.

Keywords

very low birth weight - preterm infants - antepartum hemorrhage - mortality - neonatal outcome

Publikationsverlauf

Eingereicht: 06. Januar 2020

Angenommen: 06. April 2020

Artikel online veröffentlicht:
23. Mai 2020

• References

• 1 Taylor DJ, Howie PW, Davidson J, Davidson D, Drillien CM. Do pregnancy complications contribute to neurodevelopmental disability?. Lancet 1985; 1 (8431): 713-716
• 2 Nelson KB, Ellenberg JH. Antecedents of cerebral palsy. Multivariate analysis of risk. N Engl J Med 1986; 315 (02) 81-86
• 3 Ananth CV, Wilcox AJ. Placental abruption and perinatal mortality in the United States. Am J Epidemiol 2001; 153 (04) 332-337
• 4 Matsuda Y, Maeda T, Kouno S. Comparison of neonatal outcome including cerebral palsy between abruptio placentae and placenta previa. Eur J Obstet Gynecol Reprod Biol 2003; 106 (02) 125-129
• 5 Nørgaard LN, Pinborg A, Lidegaard Ø, Bergholt T. A Danish national cohort study on neonatal outcome in singleton pregnancies with placenta previa. Acta Obstet Gynecol Scand 2012; 91 (05) 546-551
• 6 Vahanian SA, Lavery JA, Ananth CV, Vintzileos A. Placental implantation abnormalities and risk of preterm delivery: a systematic review and metaanalysis. Am J Obstet Gynecol 2015; 213 (4, Suppl): S78-S90
• 7 Klinger G, Sirota S, Luski A, Reichman B. The effect of bronchopulmonary dysplasia in very low birth weight infants on hospital length of stay – a national survey. J Perinatol 2006; 26: 640-644
• 8 Vermont-Oxford trials network database project. Manual of operations, Burlington, VT. 1993;Release 2.0. Accessed April 15, 2020 at: https://pediatrics.aappublications.org/content/103/Supplement_E1/350
• 9 Riskin A, Riskin-Mashiah S, Lusky A, Reichman B. Israel Neonatal Network. The relationship between delivery mode and mortality in very low birthweight singleton vertex-presenting infants. BJOG 2004; 111 (12) 1365-1371
• 10 Kramer MS, Platt RW, Wen SW. et al; Fetal/Infant Health Study Group of the Canadian Perinatal Surveillance System. A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics 2001; 108 (02) E35
• 11 Bancalari E, Claure N. Definitions and diagnostic criteria for bronchopulmonary dysplasia. Semin Perinatol 2006; 30 (04) 164-170
• 12 International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol 2005; 123 (07) 991-999
• 13 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
• 14 Magee LA, von Dadelszen P, Allen VM. et al; Canadian Perinatal Network Collaborative Group (Appendix 2). The Canadian Perinatal Network: a national network focused on threatened preterm birth at 22 to 28 weeks' gestation. J Obstet Gynaecol Can 2011; 33 (02) 111-120
• 15 Johansson S, Montgomery SM, Ekbom A. et al. Preterm delivery, level of care, and infant death in sweden: a population-based study. Pediatrics 2004; 113 (05) 1230-1235
• 16 Pariente G, Wiznitzer A, Sergienko R, Mazor M, Holcberg G, Sheiner E. Placental abruption: critical analysis of risk factors and perinatal outcomes. J Matern Fetal Neonatal Med 2011; 24 (05) 698-702
• 17 Salihu HM, Bekan B, Aliyu MH, Rouse DJ, Kirby RS, Alexander GR. Perinatal mortality associated with abruptio placenta in singletons and multiples. Am J Obstet Gynecol 2005; 193 (01) 198-203
• 18 Downes KL, Grantz KL, Shenassa ED. Maternal, labor, delivery and perinatal outcomes associated with placental abruption: a systematic review. Am J Perinatol 2017; 34 (10) 935-957
• 19 Chevallier M, Debillon T, Pierrat V. et al; Neurodevelopment EPIPAGE 2 Writing Group. Leading causes of preterm delivery as risk factors for intraventricular hemorrhage in very preterm infants: results of the EPIPAGE 2 cohort study. Am J Obstet Gynecol 2017; 216 (05) 518.e1-518.e12
• 20 Downes KL, Shenassa ED, Grantz KL. Neonatal outcomes associated with placental abruption. Am J Epidemiol 2017; 186 (12) 1319-1328
• 21 Klinger G, Sokolover N, Boyko V. et al. in collaboration with the Israel Neonatal Network.Perinatal risk factors for bronchopulmonary dysplasia in a national cohort of very-low-birthweight infants. Am J Obstet Gynecol 2013; 208: 115.e1-115.e9
• 22 Furukawa S, Doi K, Furuta K, Sameshima H. The effect of placental abruption on the outcome of extremely premature infants. J Matern Fetal Neonatal Med 2015; 28 (06) 705-708
• 23 Wagner BD, Sontag MK, Harris JK. et al. Prenatal complications are associated with the postnatal airway host response and microbiota in intubated preterm infants. J Matern Fetal Neonatal Med 2019; 32 (09) 1499-1506
• 24 Jeng SF, Hsu CH, Tsao PN. et al. Bronchopulmonary dysplasia predicts adverse developmental and clinical outcomes in very-low-birthweight infants. Dev Med Child Neurol 2008; 50 (01) 51-57
• 25 Kugelman A, Reichman B, Chistyakov I. et al. in collaboration with the Israel Neonatal Network. Post discharge infant mortality among very low birth weight infants: A population-based study. Pediatrics 2007; 120: e788-e794
• 26 Lee HC, Gould JB. Survival advantage associated with cesarean delivery in very low birth weight vertex neonates. Obstet Gynecol 2006; 107 (01) 97-105
• 27 Högberg U, Holmgren PA. Infant mortality of very preterm infants by mode of delivery, institutional policies and maternal diagnosis. Acta Obstet Gynecol Scand 2007; 86 (06) 693-700
• 28 Zuckerman S, Mesner O, Zmora E. Living on the Front Line: Ethical Issues in the Care of ExtremelyPremature Newborns in Israel. Curr Pediatr Rev 2013; 9: 46-49
• 29 Regev RH, Lusky A, Dolfin T, Litmanovitz I, Arnon S, Reichman B. Israel Neonatal Network. Excess mortality and morbidity among small-for-gestational-age premature infants: a population-based study. J Pediatr 2003; 143 (02) 186-191