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Risk factors associated with post-hemorrhagic hydrocephalus among very low birth weight infants of 24–28 weeks gestation

Journal of Perinatology volume 36, pages 557–563 (2016)Cite this article

Subjects

Abstract

Objective:

Post-hemorrhagic hydrocephalus (PHH) is associated with morbidity and mortality among very low birth weight (VLBW) infants. This study aimed to determine risk factors for PHH among VLBW infants with peri-intraventricular hemorrhage (PIVH).

Study Design:

This is a population-based cohort of VLBW infants of 24 to 28 weeks gestation, born in Israel from 1995 to 2012. Infants in whom a brain ultrasound was not performed before 28 days or with major congenital malformations were excluded. Univariate and multivariable analyses identified risk factors associated with PHH.

Results:

The final study cohort comprised 2811 infants with grade 2 or higher PIVH, of whom 610 (21.7%) developed PHH. PHH was independently associated with PIVH severity, with bilateral grade 3 PIVH and PIVH grade 3 and contralateral grade 4 having the highest risks (odds ratio (OR) 12.2, 95% confidence interval (CI) 8.56 to 17.4 and OR 13.7, 95% CI 9.4 to 20.1, respectively). Unilateral grade 3 or 4 PIVH's had moderately increased risks of PHH (OR 3.50, 95% CI 2.26 to 5.42 and OR 3.79, 95% CI 2.35 to 6.12, respectively). PHH was independently associated with increasing gestational age (GA) and with neonatal morbidities including patent ductus arteriosus (OR 1.47, 95% CI 1.15 to 1.88 if medically treated and OR 3.01, 95% CI 2.11 to 4.29 if surgically treated), sepsis (OR 1.79, 95% CI 1.44 to 2.22) and necrotizing enterocolitis (OR 1.60, 95% CI 1.18 to 2.17).

Conclusions:

Among VLBW infants with PIVH, PHH was independently associated with PIVH severity group, increasing GA and acute neonatal morbidities. Unilateral grade 3 or 4 PIVH was associated with a moderate risk of developing PHH compared with bilateral severe hemorrhages.

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Acknowledgements

The Israel National VLBW infant database is partially funded by the Israel Center for Disease Control and the Israel Ministry of Health.

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Authors and Affiliations

  1. Department of Neonatal Intensive Care, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel

    G Klinger, M Osovsky, N Sokolover & L Sirota

  2. Department of Pediatrics, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    G Klinger, M Osovsky, N Sokolover, L Sirota, L Lerner-Geva & B Reichman

  3. The Women and Children’s Health Research Unit, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer,, Israel

    V Boyko, L Lerner-Geva & B Reichman

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  1. G Klinger
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in collaboration with the Israel Neonatal Network

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Correspondence to G Klinger.

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Appendix A

Appendix A

The Israel Neonatal Network, which compiles the Israel national VLBW infant database, consists of these participating centers: Assaf Harofeh Medical Center, Tzrifin; Barzilai Medical Center, Ashkelon; Baruch Padeh Medical Center, Poriya, Tiberias; Bikur Cholim Hospital, Jerusalem; Bnei Zion Medical Center, Haifa; Carmel Medical Center, Haifa; Chaim Sheba Medical Center, Tel Hashomer; Emek Medical Center, Afula; French Saint Vincent de Paul Hospital, Nazareth; Hadassah University Hospital, Ein-Karem, Jerusalem; Hadassah University Hospital, Har Hazofim, Jerusalem; Hillel Yaffe Medical Center, Hadera; Holy Family Hospital, Nazareth; Kaplan Medical Center, Rehovot; Laniado Hospital, Netanya; Mayanei Hayeshua Medical Center, Bnei-Brak; Misgav Ladach Hospital, Jerusalem; Meir Medical Center, Kefar Saba; Rambam Medical Center, Haifa; Rivka Ziv Medical Center, Zefat; Schneider Children’s Medical Center of Israel and Rabin Medical Center, Beilinson Campus, Petach-Tikva; Scottish (EMMS) Hospital, Nazareth; Shaare-Zedek Medical Center, Jerusalem; Soroka Medical Center, Beer-Sheva; Sourasky Medical Center, Tel Aviv; Western Galilee Medical Center, Nahariya; Wolfson Medical Center, Holon; Yoseftal Hospital, Eilat.

Coordinating Center: Women and Children’s Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer.

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Klinger, G., Osovsky, M., Boyko, V. et al. Risk factors associated with post-hemorrhagic hydrocephalus among very low birth weight infants of 24–28 weeks gestation. J Perinatol 36, 557–563 (2016). https://doi.org/10.1038/jp.2016.18

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