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Am J Perinatol 2023; 40(11): 1193-1201
DOI: 10.1055/s-0041-1733955
Original Article

Early Vital Sign Differences in Very Low Birth Weight Infants with Severe Intraventricular Hemorrhage

Santina A. Zanelli 
1   Department of Pediatrics, University of Virginia, Charlottesville, Virginia
,
Maryam Abubakar
1   Department of Pediatrics, University of Virginia, Charlottesville, Virginia
,
Robert Andris
1   Department of Pediatrics, University of Virginia, Charlottesville, Virginia
,
Kavita Patwardhan
2   Department of Pediatrics, Division of Newborn Medicine, Washington University, St. Louis, Missouri
,
Karen D. Fairchild
1   Department of Pediatrics, University of Virginia, Charlottesville, Virginia
,
Zachary A. Vesoulis
2   Department of Pediatrics, Division of Newborn Medicine, Washington University, St. Louis, Missouri
› Author Affiliations Funding This study was supported by grants from National Institutes of Health (NIH)/National Institute of Neurological Disorders and Stroke (NINDS; grant no.: K23 NS111086; Vesoulis) and NIH/NICHD (grant no.: R01 HD072071; Fairchild), as well as by the University of Virginia Brain Institute.
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Abstract

Objective Severe intraventricular hemorrhage (sIVH, grades 3 and 4) is a serious complication for very low birth weight (VLBW) infants and is often clinically silent requiring screening cranial ultrasound (cUS) for detection. Abnormal vital sign (VS) patterns might serve as biomarkers to identify risk or occurrence of sIVH.

Study Design This retrospective study was conducted in VLBW infants admitted to two level-IV neonatal intensive care units (NICUs) between January 2009 and December 2018. Inclusion criteria were: birth weight <1.5 kg and gestational age (GA) <32 weeks, at least 12 hours of systemic oxygen saturation from pulse oximetry (SpO2) data over the first 24 hours and cUS imaging. Infants were categorized as early sIVH (sIVH identified in the first 48 hours), late sIVH (sIVH identified after 48 hours and normal imaging in the first 48 hours), and no IVH. Infants with grades 1 and 2 or unknown timing IVH were excluded. Mean heart rate (HR), SpO2, mean arterial blood pressure (MABP), number of episodes of bradycardia (HR < 100 bpm), and desaturation (SpO2 < 80%) were compared.

Results A total of 639 infants (mean: 27 weeks' gestation) were included (567 no IVH, 34 early sIVH, and 37 late sIVH). In the first 48 hours, those with sIVH had significantly higher HR compared with those with no IVH. Infants with sIVH also had lower mean SpO2 and MABP and more desaturations <80%. No significant differences in VS patterns were identified in early versus late sIVH. Logistic regression identified higher HR and greater number of desaturations <80% as independently associated with sIVH.

Conclusion VLBW infants who develop sIVH demonstrate VS differences with significantly lower SpO2 and higher mean HR over the first 48 hours after birth compared with VLBW infants with no IVH. Abnormalities in early VS patterns may be a useful biomarker for sIVH. Whether VS abnormalities predict or simply reflect sIVH remains to be determined.

Key Points

  • A higher HR in the first 48 hours is seen in infants with severe IVH.

  • Infants with sIVH have lower blood pressure in the first 48 hours.

  • Infants with sIVH have more oxygen desaturations in the first 48 hours.

Keywords

preterm infant - intraventricular hemorrhage - vital signs - very low birth weight - biomarker

Supplementary Material



Publication History

Received: 13 October 2020

Accepted: 30 June 2021

Article published online:
27 August 2021

© 2021. Thieme. All rights reserved.

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