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Incidence Trends and Risk Factor Variation in Severe Intraventricular Hemorrhage across a Population Based Cohort.

CPQCC Publication
TitleIncidence Trends and Risk Factor Variation in Severe Intraventricular Hemorrhage across a Population Based Cohort.
Publication TypeJournal Article
Year of Publication2018
AuthorsHandley SC, Passarella M, Lee HC, Lorch SA
JournalJ Pediatr
Date Published2018 09
KeywordsCalifornia, Cerebral Hemorrhage, Female, Follow-Up Studies, Gestational Age, Humans, Incidence, Infant, Newborn, Infant, Premature, Diseases, Infant, Very Low Birth Weight, Intensive Care Units, Neonatal, Male, Population Surveillance, Retrospective Studies, Severity of Illness Index

OBJECTIVE: To quantify the current burden of severe intraventricular hemorrhage (IVH), describe time trends in severe IVH, identify IVH-associated risk factors, and determine the contribution of mediating factors.

STUDY DESIGN: The retrospective cohort included infants 22-31 weeks of gestation without severe congenital anomalies, born at hospitals in the California Perinatal Quality Care Collaborative between 2005 and 2015. The primary study outcome was severe (grade III or IV) IVH.

RESULTS: Of 44 028 infants, 3371 (7.7%) had severe IVH. The incidence of severe IVH decreased significantly across California from 9.7% in 2005 to 5.9% in 2015. After stratification by gestational age, antenatal steroid exposure was the only factor associated with a decreased odds of severe IVH for all gestational age subgroups. Other factors, including delivery room intubation, were associated with an increased odds of severe IVH, though significance varied by gestational age. Factors analyzed in the mediation analysis accounted for 45.6% (95% CI 38.7%-71.8%) of the reduction in severe IVH, with increased antenatal steroid administration and decreased delivery room intubation mediating a significant proportion of this decrease, 19.4% (95% CI 13.9%-27.5%) and 27.3% (95% CI 20.3%-39.2%), respectively. The unaccounted proportion varied by gestational age.

CONCLUSIONS: The incidence of severe IVH decreased across California, associated with changes in antenatal steroid exposure and delivery room intubation. Maternal, patient, and delivery room factors accounted for less than one-half of the decrease in severe IVH. Study of other factors, specifically neonatal intensive care unit and hospital-level factors, may provide new insights into policies to reduce severe IVH.

Alternate JournalJ. Pediatr.
PubMed ID29754865
PubMed Central IDPMC6109595
Grant ListT32 HD007440 / HD / NICHD NIH HHS / United States