Abstract 1426 Poster Session III, Monday, 5/3 (poster 35)

The purpose of this study was to 1) determine whether the incidence of IVH among infants <1250 grams had decreased between 1991 and 1997 secondary to ↑ use of maternal steroids, surfactant and prophylactic indomethacin, 2) determine neurodevelopmental outcome relative to degree of IVH, and 3) identify relevant risk factors associated with IVH and with outcome at 12-18 mo. This was an observational study of 929 live births <1250 grams with 755 (81.3%) survivors; 47% of the expired and 31% of the survivors had IVH (p<0.001). (Table) There were no significant changes in the survival or IVH rates from 1991 and 1997. Logistic regression models were run to determine risk factors associated with IVH. Factors examined were gest. age, maternal steroids, SGA, c-section, Apgars <7, surfactant and indomethacin. Increased gest. age (p<0.0002), maternal steroids (p<0.003), and c-section (p<0.02) were associated with a ↓ risk of IVH. Surfactant use (p<0.001) and Apgar <7 (p<0.025) were associated with an ↑ risk of IVH. Logistic regressions were also run for the prediction of an MDI <70, a PDI <70 and an abn/susp neurological exam entering gest. age, SGA, Apgars <7, male gender, postnatal steroids BPD and IVH. Only IVH (p<0.0002) was associated with an MDI <70 at 12-18 months. Postnatal steroids (p<0.01) and IVH (p<0.0001) were associated for a PDI <70. BPD (p<0.04) and IVH (p<0.001) were associated with an abn/susp neurologic exam at 12-18 months. We conclude that although the incidence of IVH among VLBW infants in the 90's appears to have stabilized, severe grades of IVH continue to be a major cause of morbidity including poor mental, motor and neurologic outcomes. Multivariate analysis revealed that the only proposed intervention protective of IVH was use to prenatal steroids. Further prospective study of the long term effects of perinatal interventions on outcome of infants with IVH is recommended.

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