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Severe intraventricular hemorrhage and withdrawal of support in preterm infants

Journal of Perinatology volume 37, pages 441–447 (2017)Cite this article

Subjects

Abstract

Objective:

The objective of the study was to determine whether withdrawal of support in severe ‘intraventricular hemorrhage’ (IVH), that is, IVH grade 3 and periventricular hemorrhagic infarction (PVHI), has decreased after publication of studies that show improved prognosis and to examine cranial ultrasonograms, including PVHI territories defined by Bassan.

Study Design:

Retrospective cohort of preterm infants from 23 0/7 to 28 6/7 weeks’ gestation in 1993 to 2013.

Results:

Among the 1755 infants, 1494 had no bleed, germinal matrix hemorrhage (GMH) or IVH grade 2, 137 had grade 3 IVH and 124 had PVHI. The odds of withdrawal of support, adjusted for severity of GMH-IVH and baseline variables, did not decrease after publications showing better prognosis. Among 82 patients who died with PVHI, 76 had life support withdrawn, including 34 without another contributing cause of death. The median number of PVHI territories involved was three.

Conclusion:

Withdrawal of support adjusted for severity of GMH-IVH did not significantly change after publications showing better prognosis.

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Author information

Author notes

  1. J W Sheehan

    Present address: 4Current address: Hospital of Central Connecticut, Hartford HealthCare, New Britain, CT, USA.,

Authors and Affiliations

  1. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA

    J W Sheehan, R J Heyne, M A Jaleel, W D Engle, P J Burchfield & L P Brion

  2. Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    M Pritchard

  3. Parkland Health and Hospital System, Dallas, TX, USA

    L S Brown

Authors
  1. J W Sheehan
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Corresponding author

Correspondence to L P Brion.

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The authors declare no conflict of interest.

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Author contributions

Dr Sheehan wrote the first draft of the manuscript. She conceptualized and designed the study. She reviewed data from the database, medical records, participated in the interpretation of the data, critically reviewed revisions and approved the final manuscript. Dr Pritchard conceptualized and designed the study. She reviewed and classified all the ultrasonograms using predefined criteria, without knowledge of prior readings and outcome and participated in data interpretation and critically reviewed the manuscript. Dr Heyne conceptualized and designed the study. He participated in the interpretation of the data, follow-up data review and abstraction, critically reviewed and approved the final manuscript. Mr Brown conceptualized and designed the study. He completed all statistical analyses, participated in the interpretation of the data and critically reviewed the manuscript. Dr Jaleel and Dr Engle conceptualized and designed the study. They participated in the interpretation of the data, critically reviewed and approved the manuscript. Ms Burchfield collected and entered data into the databases and extracted the data for this study. She participated in the interpretation of the data, critically reviewed the manuscript and approved the final manuscript as submitted. Dr Brion conceptualized and designed the study. He participated in the interpretation of the data, critically reviewed, revised and approved the manuscript.

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Sheehan, J., Pritchard, M., Heyne, R. et al. Severe intraventricular hemorrhage and withdrawal of support in preterm infants. J Perinatol 37, 441–447 (2017). https://doi.org/10.1038/jp.2016.233

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