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Interdisciplinary surveillance of intraventricular haemorrhage associated conditions in infants <1000 g
Author(s) -
Obladen Michael,
Metze Boris,
Henrich Wolfgang,
Aktas Ayse,
Czernik Christoph,
SchulzBaldes Annette
Publication year - 2008
Publication title -
acta pædiatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/j.1651-2227.2008.00812.x
Subject(s) - medicine , prospective cohort study , incidence (geometry) , pediatrics , hypocapnia , acidosis , neonatology , intraventricular hemorrhage , low birth weight , retinopathy of prematurity , gestational age , obstetrics , anesthesia , pregnancy , physics , biology , optics , genetics , hypercapnia
Aim: Intraventricular haemorrhage (IVH) causes some of the most adverse outcomes in infants with birthweight <1000 g. Incomplete antenatal steroids, acidosis, inflammation, postnatal transfer, delayed surfactant administration, hypothermia, hypotension, hypocapnia, persistent ductus arteriosus and pneumothorax are all associated with IVH. We hypothesized that prospective surveillance of these IVH‐associated conditions decreases their frequency and thus the frequency of IVH. Methods: Cranial ultrasound was performed on days 1, 3, 7, 30 after birth and at discharge, and was assessed according to Papile. The incidence of IVH and IVH‐associated conditions was monitored prospectively in all infants <1000 g born in our perinatal centre in 2005/2006, and obstetricians and neonatologists held monthly interdisciplinary review conferences to discuss the preventability of IVH‐associated conditions (IVH surveillance). These data were compared to existing prospective data gathered during routine monitoring in 2004. Results: IVH (all grades) occurred in 29/86 extremely low birthweight (ELBW) infants during routine monitoring and in 12/89 ELBW infants during IVH surveillance (p = 0.007). IVH grades 3–4 dropped from 20% to 3.4% (p = 0.0006). There were significant differences in completeness of antenatal steroids (54% vs. 67%, p = 0.04) and timeliness in initial surfactant substitution (45% vs. 71%, p = 0.01). Most other IVH‐associated conditions were reduced during IVH surveillance without reaching significance. Conclusions: IVH is not always an inevitable disaster. Obstetricians and neonatologists can reduce its incidence by joint prospective surveillance of IVH‐associated conditions.