Predictive Risk Factors for Mild and Severe Germinal Matrix Hemorrhage and Associated Neurodevelopmental Prognosis: A Retrospective Study
Wejdan Alhakeem *
Collage of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Afnan Almuhana
Department of Radiology, King Fahad University Hospital, Khobar, Saudi Arabia.
Haya Alshahrani
Collage of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Moneerah Alkhateeb
Collage of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Zahra Alsaihati
Collage of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
*Author to whom correspondence should be addressed.
Abstract
Aims: To compare commonly mentioned risk factors between mild germinal matrix hemorrhage-Intraventricular hemorrhage (GMH-IVH) (grade I & II) and severe GMH-IVH (grade III & IV) and to study the long-term neurodevelopmental outcomes in relation to severe GMH-IVH.
Study Design: Retrospective cohort study.
Place and Duration of Study: Neonatal intensive care unit, King Fahad University Hospital, between 2000 and 2020.
Methodology: We included 54 premature infants at ≤36 weeks of gestation and with birth weight <2500g admitted to our neonatal intensive care unit. Premature neonates were divided into two subgroups: mild GMH-IVH (grade I and II) and severe (grade III and IV). We investigated the risk factors and neurodevelopmental outcomes in association with GMH-IVH.
Results: Amnionitis (OR: 1.190, 95% CI 0.515-2.749), lower genital tract infection (OR: 1.190, 95% CI 0.515-2.749), antenatal infection (OR: 1.406, 95% CI 0.866-2.283), gestational diabetes mellitus (OR: 1.815, 95% CI 1.410-2.337), usage of inotropes (OR: 1.731, 95% CI 1.348-2.222), APGAR score <7 (OR: 0.806, 95% CI 0.493-1.316), birth trauma (OR: 1.767, 95% CI 1.396-2.236), catecholamines (OR: 1.470, 95% CI 0.903-2.393), intubation (OR: 1.300, 95% CI 0.686-2.464), asphyxia (OR: 1.135, 95% CI 0.718-1.794), Abnormal coagulation (OR: 1.197, 95% CI 0.756-1.896), congenital heart disease (OR: 1.727, 95% CI 1.124-2.653), low hematocrit (OR: 1.140, 95% CI 0.688-1.889), resuscitation (OR: 1,193, 95% CI 0.748- 1.904) and ventriculoperitoneal (VP) shunt as a prognosis of hydrocephalus (P-value: 0.005) all showed a higher incidence with severe GMH-IVH
Conclusion: Amnionitis, lower genital tract infection, antenatal infections, GDM, usage of inotropes, APGAR score <7, birth trauma, catecholamines, intubation, asphyxia, resuscitation, abnormal coagulation parameters, congenital heart disease, low hematocrit and hydrocephalus with VP shunt were higher in severe GMH-IVH.
Keywords: Germinal matrix hemorrhage, intraventricular hemorrhagel preterm neonates, risk factors, neurodevelopmental outcomes