Risk factors of periventricular-intraventricular hemorrhage in premature infants / 中国小儿急救医学

ABSTRACT

Objective:To analyze the potential risk factors of periventricular-intraventricular hemorrhage(PIVH)in premature infants.Methods:A retrospective study was conducted on clinical data of 279 premature infants admitted to the Affiliated Hospital of Guizhou Medical University From January 1, 2019 to December 31, 2019, who completed cranial ultrasound during hospitalization.According to the cranial ultrasound with or without PIVH, the cases were divided into PIVH group and non-PIVH group.The premature infants with PIVH were divided into severe PIVH(grade Ⅲ and Ⅳ)group and mild PIVH(grade Ⅰand Ⅱ)group according to the PIVH grades.A total of 25 factors, which may influnce PIVH, were analyzed by univariate analysis, and then multivariate Logistic stepwise regression analysis(stepwise backwards method)was performed to determine the major risk factors.Results:(1)A total of 279 premature infants were included in the study, 133 of them in PIVH group, and 146 of them in non-PIVH group.Univariate analysis showed that there were statistically significant differences in 14 factors between two groups, including full treatment of antenatal steroid, gestation age, birth weight, neonatal asphyxia, hypothermia, early onset sepsis, metabolic acidosis, hypernatremia, anemia, respiratory distress syndrome, noninvasive ventilation, invasive ventilation, invasive ventilation within 72 hours after birth, and lumbar puncture within 72 hours after birth( P<0.05). Multivariate analysis showed that gestational age( OR=0.709, 95% CI 0.602-0.835), and full treatment of antenatal steroid( OR=0.354, 95% CI 0.189-0.664) were protective factors for PIVH in premature infants, while neonatal asphyxia( OR=2.425, 95% CI 1.171-5.023), hypothermia( OR=2.097, 95% CI 1.088~4.041), early onset sepsis( OR=12.898, 95% CI 1.433-115.264), metabolic acidosis( OR=2.493, 95% CI 1.398-4.442), invasive ventilation within 72 hours after birth( OR=5.408, 95% CI 1.156-25.297), lumbar puncture within 72 hours after birth ( OR=5.035, 95% CI 1.269-19.993) were independent risk factors for PIVH in premature infants( P<0.05). (2) Among 133 cases of premature PIVH, 20 cases were severe PIVH and 13 cases were mild PIVH.Univariate analysis showed that there were statistically significant differences in 5 factors between two groups, including antenatal magnesium sulfate, gestation age, early onset sepsis, abnormal coagulation, and lumbar puncture within 72 hours after birth.Multivariate analysis showed that early onset sepsis( OR=4.392, 95% CI 1.343-14.367) and abnormal coagulation( OR=3.502, 95% CI 1.234-9.867) were independent risk factors for severe PIVH in premature infants( P<0.05). Conclusion:Gestational age is negatively correlated with the occurrence of PIVH in premature infants, and completion of more than a course of treatment for antenatal dexamethasone is an independent protective factor of PIVH in premature infants.Neonatal asphyxia, metabolic acidosis, hypothermia(<35 ℃), early onset sepsis, invasive ventilation within 72 hours after birth, and lumbar puncture within 72 hours after birth are independent risk factors for PIVH in premature infants.Abnormal coagulation and early onset sepsis are independent risk factors for severe PIVH in premature infants.