24 • PERINATOLOGY Vol 24 • No. 1 • May–Aug 2023 Original Article Kulkarni PP, et al. Assessment of Risk Factors of Intraventricular Hemorrhage Among Preterm Neonates Table 5. Association Between Gestational Age and the Incidence of IVH Gestational Age No. of Neonates Cases (n = 50), n (%) Controls (n = 114), n (%) ≤ 28 wk 8 6 (75) 2 (25) 28 wk 1 d to 31 wk 51 21 (41.2) 30 (58.8) 31 wk 1 d to ≤ 34 wk 105 23 (21.9) 82 (78.1) P value < .05. IVH, intraventricular hemorrhage. than those born preterm and vaginally. The association between the incidence of IVH and the mode of delivery was statistically significant.11 In Ment et al’s11 study, vaginal delivery was a significant risk factor of IVH. Some observational studies suggest a correlation between adverse outcomes in preterm neonates and vaginal delivery.11 Our study results show that multiple pregnancy can also be a risk factor of IVH. It significantly influences gestational age and birth weight. Our study results are on similar lines with that of the study conducted by Pekcevik et al.12 With regard to antenatal steroids, administering 2 doses of betamethasone 12 hours apart, with the last dose given nearly 12 hours before the neonate was born is considered to be protective against IVH, respiratory distress syndrome, and necrotizing enterocolitis. Studies show that betamethasone is far superior to dexamethasone in its neuroprotective effect.13 In our study, we found that antenatal steroids have a protective effect in preventing IVH. Our results were similar to that of Pekcevik et al’s study.12 Neonatal resuscitation in the delivery room was one of the predictors of hemorrhage. The time at which ventilation was initiated as well as the duration of ventilation are important determinants of IVH. Risk of occurrence of severe IVH in preterm neonates who never had intubation in the delivery room or during the first 3 days of life was reported to be minimum.14 Some studies have mentioned that preterm neonates requiring mechanical ventilation at birth were found to have an increased risk of IVH. This indicates that these factors are associated with fluctuations in blood pressure in preterm neonates, which is thought to be the main cause of IVH. Our results were similar to that of other studies.15,16 Neonates with lesser birth weight are at a higher risk of developing IVH, which was also concluded by Vural et al16 and Bassan et al17 studies. It was observed, in our study, that lesser the gestational age, higher the chances of developing IVH. Figure 2. Association Between the Birth Weight and the Incidence of IVH P value < .05. IVH, intraventricular hemorrhage. As shown in Figure 2, of the 20 neonates born with a birth weight of ≤ 1000 g, 70% (n = 14) of the neonates developed IVH. Of the 144 neonates born with a birth weight of 1000 to 1500 g, 25% (n = 36) of the neonates developed IVH. IVH was more frequently observed among the neonates born with a birth weight of < 1000 g compared with those born with a birth weight of 1000 to 1500 g. This difference was statistically significant. Discussion In our study, IVH was more frequently observed among male neonates than female neonates. Our study results correlate with that of the study conducted by Mohamed et al,10 which included 104,847 VLBW and ELBW neonates with gestational age ≤ 34 weeks. The data were collected over a period of 6 years from 1000 hospitals. In our study, it was observed that IVH was less frequently found among the neonates born through LSCS 0 < 1000 1000–1500 Cases Control 20 40 60 80 100 120 Birth Weight, g Incidence of IVH, %
RkJQdWJsaXNoZXIy MjAwNDg=