22 • PERINATOLOGY Vol 24 • No. 1 • May–Aug 2023 Original Article Kulkarni PP, et al. Assessment of Risk Factors of Intraventricular Hemorrhage Among Preterm Neonates segment cesarean section and receiving a full course of antenatal steroids were found to be protective. Key Words: Intraventricular hemorrhage, very low birth weight, extremely low birth weight, preterm, cranial ultrasound, resuscitation, antenatal steroids Introduction The incidence of intracranial hemorrhage varies from 2% to 30% in neonates, depending on the gestational age at birth and the type of intracranial hemorrhage.1 Hemorrhage within the skull can occur either in the epidural, subdural, and subarachnoid space; parenchyma; or ventricles. Hemorrhage usually occurs spontaneously in premature neonates.2 It has been observed that most instances of intracranial bleeding occur within the first 3 to 4 days of life.3,4 Intraventricular hemorrhage (IVH) in neonates can be associated with complications such as hydrocephalus, which may need treatment and long-term followup. Cranial ultrasound is useful in diagnosing IVH in neonates. Most of the hemorrhages are asymptomatic in neonates born before 34 weeks of gestation.5,6 IVH accounts for 30% to 40% of the global disease burden,7,8 and it is the third leading cause of neonatal morbidity.9 In many studies conducted in western countries, it has been shown that up to 36% of the neonatal morbidities and mortality occur among lowbirth-weight (LBW) neonates. Knowing the risk factors that cause IVH may aid in early detection and early intervention. Aim To determine the risk factors of IVH among very LBW (VLBW) and extremely LBW (ELBW) neonates Materials and Methods Study design This case–control study was conducted at the NICU of Shri Dharmasthala Manjunatheshwara (SDM) College of Medical Sciences and Hospital (Dharwad, Karnataka, India), for 1 year (from November 1, 2014, to October 31, 2015). During the study period, 164 preterm VLBW (< 1500 g) and ELBW (< 1000 g) neonates at gestational age ≤ 34 weeks were admitted to the NICU. Gestational age was assessed using modified Ballard’s scoring. This study was approved by the institutional ethics committee. Inclusion criteria All inborn neonates at gestational age ≤ 34 weeks and with ELBW and VLBW admitted to the NICU during the study period were included in the study. Exclusion criteria Neonates born with major congenital malformations (particularly those affecting the central nervous system such as hydranencephaly, anencephaly, encephalocele, and chromosomal abnormalities), birth weight > 1500 g, and gestational age > 34 weeks and outborn neonates were excluded from the study. Study procedure Neonates with gestational age ≤ 34 weeks, with a birth weight ≤ 1500 g were screened using cranial ultrasound, within 72 to 96 hours of life. The neonates who had IVH were included as cases, and those who did not have any hemorrhage were included as controls and observed till day 7 of life. Among the neonates who had features suggestive of a hemorrhage such as apnea, sudden pallor, and bulging anterior fontanelle, the cranial ultrasound was repeated. Statistical analyses All relevant data were collected in the predesigned proforma after obtaining informed consent from parents
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