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A predictive clinical model for moderate to severe intraventricular hemorrhage in very low birth weight infants

Abstract

Importance

Intraventricular hemorrhage (IVH) occurs in 15–45% of all very low birth weight (VLBW) preterm infants. Despite improvements in the perinatal care, the incidence of IVH remains high. As more preterm infants survive, there will be a larger burden of neurodevelopmental abnormalities borne by former preterm infants.

Objective

The objective of this study was to develop a predictive clinical model of IVH risk within the first few hours of life in an effort to augment perinatal counseling and guide the timing of future targeted therapies aimed at preventing or slowing the progression of disease.

Design

This is a prospective observational cohort study of VLBW infants born in the NICU at John’s Hopkins Children’s Center from 2011 to 2019. The presence and severity of IVH was defined on standard head ultrasound screening (HUS) using the modified Papile classification. Clinical variables were identified as significant using absolute risk regression from a general linear model. The model predictors included clinically meaningful variables that were not collinear.

Setting

This study took place at the Johns Hopkins Children’s Center Level IV NICU.

Participants

The study sample included VLBW infants treated in the neonatal intensive care unit (NICU) at John’s Hopkins Children’s Center from 2011 to 2019. A total of 683 infants included in the study had no or grade I IVH, and 115 infants had grades II through IV IVH. Exclusion criteria included admission to the JHH NICU after 24 h of age, BW > 1500 g, and failure to consent.

Main Outcome

The main outcome of this study was the presence of grades II-IV IVH on standard head ultrasound screening using the modified Papile classification [1].

Results

A total of 798 VLBW infants were studied in this cohort and 14.4% had moderate to severe IVH. Fifty four percent of the cohort was black, 33% white, and half of the cohort was male. A higher gestational age, 5-min Apgar score, hematocrit, and platelet count were significantly associated with decreased incidence of IVH in a multi-predictor model (ROC 0.826).

Conclusion and relevance

In the face of continued lack of treatments for IVH, prevention is still a primary goal to avoid long-term developmental sequela. This model can be used for perinatal counseling and may provide important information during the narrow therapeutic window for targeted prevention therapies.

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Fig. 1: ROC curves comparing the Lee model to the new proposed model [33, 34].

Data availability

Request for data sharing should be submitted to the corresponding author for consideration.

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Acknowledgements

This work is dedicated to Phoebe Marie Teng, Eli Joseph Teng, and Caleb Edward Teng who passed from IVH.

Funding

Grant funding for this project-(R01HD086058) (ADE, EMG, FJN, DV).

Author information

Authors and Affiliations

Authors

Contributions

FJN had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. RMW and FJN developed the study design, assisted with the data analysis, and interpreted the data. RMW created the tables and wrote the manuscript with support from FJN, EMG, ADE, and DV. CP assisted with data collection and ensured accuracy of the data. DV performed the data analysis and revised the manuscript.

Corresponding author

Correspondence to Frances J. Northington.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval

The study was approved by Johns Hopkins University IRB. Information was collected under IRB 00026068 for the duration of the study. In 2018, the IRB began requiring consent from parent/guardian for inclusion in the study, and consent in both English and Spanish were obtained forthwith.

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Weinstein, R.M., Parkinson, C., Everett, A.D. et al. A predictive clinical model for moderate to severe intraventricular hemorrhage in very low birth weight infants. J Perinatol (2022). https://doi.org/10.1038/s41372-022-01435-0

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