Perinatal Factors that Influence the Incidence of Subependymal and Intraventricular Hemorrhage in Low Birthweight Infants

ABSTRACT

A total of 95 preterm infants, delivered consecutively in a perinatal center, over a 9-month period, were studied serially with real-time ultrasound for detection of subependymal/intraventricular hemorrhage (SEH/IVH); all infants were < 32-week gestation and/or < 1500 gm birthweight. Detailed statistical analysis was carried out to determine the influence of perinatal factors on the occurrence of SEH/IVH. The incidence of SEH/IVH was 34%; severe hemorrhage (Grade III-IV) occurred in only 13%. Gestational age was an important factor associated with SEH/IVH. Thus, the incidence in infants < 29-weeks gestation was 45%, whereas in infants > 29-weeks gestation age, it was 19% (p < 0.01). The overall incidence of SEH/IVH in the group which was < 29-weeks gestation and delivered by cesarean section was 53%, whereas in those infants delivered vaginally it was 47%. In infants whose gestational age was < 29-weeks, the incidence of hemorrhage was 47% if delivered vaginally and presenting as a vertex and 31% if delivered by cesarean section. In infants > 29-weeks gestation, the incidence of SEH/IVH was 42% in those delivered by the vaginal vertex route, 5% if presentation was vertex and delivered by cesarean section (p < 0.05).

In infants > 29-weeks gestation, cesarean section in vertex presentation decreased the incidence of SEH/IVH when compared with vaginal vertex delivery. The incidence of SEH/IVH was higher in breech presentation (50%) than in vertex presentation (17%) even when all were delivered by cesarean section. There was no change in the incidence of SEH/IVH with the occurrence of labor, and the incidence was low in infants who were small for gestational age.