THE PREVALENCE AND CLINICAL CORRELATES OF INTRAVENTRICULAR HAEMORRHAGE AMONG PRETERM NEONATES IN LAGOS

Abstract

Intraventricular haemorrhage (IVH) is an important cause of morbidity and mortality especially
in preterm neonates. There is however, a paucity of studies among Nigerian neonates to
establish the true burden of the disease. Cranial ultrasonography (cUS) is a simple, safe, non
invasive test to view the presence or absence of IVH and also to stage the IVH for prompt care
and prognosis.
The aim of the study is to determine the prevalence and clinical / laboratory correlates of IVH
among preterm neonates. The correlates includes Apgar scores, apnoea, changes in packed cell
volume and changes in platelet count. The study was hospital based, prospective and
descriptive. It was carried out at the neonatal unit of Lagos State University Teaching Hospital
(LASUTH).
A total of 254 subjects were recruited after parental consent. Twenty one subjects died before
completion of the four scheduled cUS, while thirteen were referred out of the study centre.
Thus 220 preterm neonates were studied.
The pregnancy history was sought from the mothers before the subjects were examined.
Physical examination findings such as, APGAR scores, heart rate, respiratory rate, muscle tone,
pallor, cyanosis were documented in the proforma. Subjects were weighed using a Wincom®
mechanical baby scale. Two millilitres of blood was drawn from the peripheral vein of subjects
and full blood count was performed on the first and seventh days of life using a Coulter LH
750; an automated analyser.
Cranial ultrasonography was performed with Acuson P50 portable ultrasound machine at the
incubator/bedside of subjects. A total of four cUS were performed within 24 hours, 48 hours,
fifth and seventh day of life. The data was stored and analysed with Statistical Package for
Social Sciences (SPSS version 20).
The study subjects consisted of five extreme low birth weight, ninety five very low birth weight
(VLBW), one hundred and ten other low birth weight and ten subjects had normal weight.
There were one hundred and fifteen males and one hundred and five females, gestational age
of subjects was between twenty eight weeks and thirty six weeks three days. About a quarter
of the subjects were less than or thirty weeks gestation. Also, about a third of mothers were
unbooked and almost 20% of mothers were teenagers.
Twenty eight of the 220 subjects had IVH giving a prevalence of 12.7%. The prevalence was
14.8% among 115 males and 10.5% among 105 females (p = 0.34). IVH occurred exclusively
among very low birth weight babies (<1500g) and extreme low birth weight subjects (<1000g).
The prevalence rate of IVH among 95 VLBW and 5 ELBW subjects was 28.0%. Similarly,
IVH occurred exclusively among babies born at gestational of 30 weeks or below, with a
prevalence rate of 54.9% (28 of 51 babies). Nineteen subjects had grade 1 IVH, four developed
grade 2 IVH and five had grade 3 IVH. The prevalence of IVH was 3.5 times more likely to
occur among vaginal delivery than in caesarean section (17.3% vs. 4.9%: p = 0.011). The
highest yield of subjects with IVH (15) was observed between 48 hours and day 5. There was
no sex predilection for IVH (p = 0.126). All the subjects with intraventricular haemorrhage had
recurrent apnoea. IVH was exclusive to subjects with Apgar score less than 7 at 1 minute. Less
than 5% of subjects who developed IVH had Apgar score greater than 6 at five minutes. A drop
in PCV greater than 6% and a drop in platelet count greater than 50000/µl in the first week was
strongly associated with the occurrence of IVH.
In conclusion, IVH occurred exclusively among VLBW babies and preterm infants with
gestational age of 30 weeks and below. Caesarean section was found to be protective against
occurrence of IVH. Cranial Ultrasonography should be performed on preterm babies of
gestational age ≤ 30 weeks or weighing less than 1500g. Babies experiencing recurrent apnoea
should also be screened using cUS.

THE PREVALENCE AND CLINICAL CORRELATES OF INTRAVENTRICULAR HAEMORRHAGE AMONG PRETERM NEONATES IN LAGOS