Risk factors for developing intraventricular haemorrhage in very low-birthweight infants at Kalafong Provincial Tertiary Hospital, South Africa, 2019 - 2020
Article Sidebar
Main Article Content
Abstract
Background. Intraventricular haemorrhage (IVH) remains a major concern as a result of the high prevalence of preterm births globally.
Objectives. To identify maternal and neonatal risk factors associated with IVH, and to assess its incidence and most frequently occurring grade in a population of very low-birthweight infants (VLBWIs) at Kalafong Provincial Tertiary Hospital, South Africa (SA).
Methods. This retrospective cohort study included all infants of birthweight <1 500 g admitted between 1 January 2019 and 31 December 2020. Associations between IVH and maternal and neonatal risk factors were analysed using Pearson’s χ2 test and Fisher’s exact test. Risk factors significantly associated with IVH were included in a binary logistic regression model to identify independent predictors. Risk factors significantly associated with IVH (p<0.05) corresponded to a 95% confidence level.
Results. IVH was diagnosed during the first week of life in 43 out of 127 VLBWIs who met the inclusion criteria. Hypoglycaemia remained the most significant independent risk factor after adjusting for potential confounders in the multivariable logistic regression: adjusted odds ratio 4.02 (95% confidence interval (CI) 1.52 - 10.64). The incidence of IVH was 33.9% (95% CI 25.7 - 42.1). Grade I IVH occurred in 83.7% of infants, grade II in 9.3% and grades III - IV in 7.0%.
Conclusion. This study found an association between hypoglycaemia and IVH, but causality could not be established owing to the nature of the study. In this tertiary hospital in SA, a third of VLBWIs had IVH, mostly graded as mild.
Article Details
Section
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The SAJCH is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
How to Cite
References
1. World Health Organization. Preterm birth. 10 May 2023. https://www.who.int/ news-room/fact-sheets/detail/preterm-birth (accessed 4 January 2025).
2. Basiri B, Sabzehei MK, Shokouhi-Solgi M, Khanlarzadeh E, Mosheiri M. The frequency of intraventricular hemorrhage and its risk factors in premature neonates in a hospital’s NICU. Iran J Child Neurol 2021;15(3):109-118. https:// doi.org/10.22037/ijcn.v15i3.21592
3. Rees P, Callan C, Chadda KR, et al. Preterm brain injury and neurodevelopmental outcomes: A meta-analysis. Pediatrics 2022;160(6):e2022057442. https://doi. org/10.1542/peds.2022-057442
4. Mostafa-Gharehbaghi M, Khanzadeh N, Mahallei M, Samani FG. Short-term outcome of preterm infants with intraventricular hemorrhage. Zahedan J Res Med Sci 2023;25(4):e126736. https://doi.org/10.5812/zjrms-126736
5. Reddy PA, Sreenivasulu H, Shokrolahi M, et al. Navigating the complexities of intraventricular hemorrhage in preterm infants: An updated review. Cureus 2023;15(5):e38985. https://doi.org/: 10.7759/cureus.38985
6. Ghoor A, Scher G, Ballot DE. Prevalence of and risk factors for cranial ultrasound abnormalities in very-low-birth-weight infants at Charlotte Maxeke Johannesburg Academic Hospital. S Afr J Child Health 2017;11(2):66-70. https://doi.org/10.7196/SAJCH.2017.v11i2.1167.
7. Akuamoah-Boateng G, Moon TD, Amorim G, Bandini R, Ballot D. Intraventricular hemorrhage among very low birth weight infants in a South African cohort: A retrospective study of trends & short-term outcomes. BMC Pediatr 2025;25(1):138. https://doi.org/10.1186/s12887-025-05426-w
8. Maduray F, Masekela R. A retrospective study on the prevalence, severity and outcomes of intraventricular haemorrhage in infants with a low birth weight in a quaternary hospital in a low- to middle-income country. S Afr J Child Health 2019;13(2):56-62. https//doi.org/10.7196/SAJCH.2019.v13i2.1529
9. Mokoto T. Prevalence and risk factors for intraventricular haemorrhage and periventricular leukomalacia in very low birth weight infants at Rahima Moosa Mother and Child Hospital. MMed (Paed) dissertation. Johannesburg: University of the Witwatersrand, 2022. https://wiredspace.wits.ac.za/ items/93d2e15a-c366-4e18-b65f-308f1fce174e (accessed 4 April 2025).
10. Tshehla RM, Coetzee M, Becker PJ. Mortality and morbidity of very low- birthweight and extremely low-birthweight infants in a tertiary hospital in Tshwane. S Afr J Child Health 2019;13(2):89-97. https://doi.org/10.7196/ SAJCH.2019.v13i2.1582
11. Dormohamed N, Lloyd L, van Wyk L. Outcomes of periviable neonates born and admitted to a resource-limited hospital, Cape Town, South Africa. S Afr J Child Health 2022;16(1):32-38. https://doi.org/10.7196/SAJCH.2022.v16. i1.1835
12. Hand IL, Shellhaas RA, Milla SS; Committee on Fetus and Newborn, Section on Neurology, Section on Radiology; Cummings JJ, Adams-Chapman IS, Aucott SW, et al. Pediatrics 2020;146(5):e2020029082. https://doi.org/10.1542/ peds.2020-029082
13. Papile LA, Burstein J, Burnstein 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(4):529-553. https://doi. org/10.1016/s0022-3476(78)80282-0
14. Hoque AM, Buckus S, Hoque M. Association between antenatal care and preterm birth: A retrospective study. Acad J Pediatr Neonatol 2022;11(4):555871. https://doi.org/10.19080/AJPN.2022.11.555871
15. Huang J, Meng J, Choonara I, et al. Antenatal infection and intraventricular hemorrhage in preterm infants. Medicine 2019;98(31):e16665. https://doi. org/10.1097/MD.0000000000016665
16. Denicol MM, Leott VB, Soares de Soares CR, Hilgert JB. Early-onset neonatal sepsis as a risk factor for peri-intraventricular hemorrhage in premature infants. Rev Bras Epidemiol 2024;27:e240013. https://doi.org/10.1590/1980- 549720240013
17. St Peter D, Gandy C, Hoffman SB. Hypotension and adverse outcomes in prematurity: Comparing definitions. Neonatology 2017;111(3):228-233. https://doi.org/10.1159/000452616
18. Sharma A, Davis A, Shekhawat PS. Hypoglycemia in the preterm neonate: Etiopathogenesis, diagnosis, management and long-term outcomes. Transl Pediatr 2017;6(4):335-348. https://doi.org/10.21037/tp.2017.10.06
19. McLeod R, Paulson JN, Okalany N, et al. Intraventricular haemorrhage in a Ugandan cohort of low birth weight neonates: The IVHU study. BMC Pediatr 2021;21(12). https://doi.org/10.1186/s12887-020-02464-4
20. Siffel C, Kistler KD, Sarda SP. Global incidence of intraventricular hemorrhage among extremely preterm infants: A systematic literature review. J Perinat Med 2021;49(9):1017-1026. https://doi.org/10.1515/jpm-2020-0331
21. Fortmann I, Mertens L, Boeckel H, et al. A timely administration of antenatal steroids is highly protective against intraventricular hemorrhage: An observational multicenter cohort study of very low birth weight infants. Front Pediatr 2022;10:721355. https://doi.org/10.3389/fped.2022.721355