Peer-reviewed article
Intraventricular haemorrhage (IVH) and associated clinical characteristics in outborn preterm infants <32 weeks undergoing neonatal transport in Western Australia: a retrospective cohort study (2011-2021).
Desai S, Joseph M, George K, Tan KN, Dempsey Z et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined intraventricular haemorrhage (IVH), a serious brain bleeding condition, in premature infants born before 32 weeks gestation in Western Australia. Researchers analysed medical records from 286 infants transported to tertiary care between 2011 and 2021. IVH occurred in about 20% of infants, and the study found that perinatal factors like intra-amniotic inflammation and certain resuscitation drugs were more strongly associated with IVH than transport characteristics. The findings suggest that optimising management during preterm labour and birth may be more important than transport factors in preventing this complication.
Key points
- IVH occurred in 19.9% of outborn preterm infants <32 weeks on day 1 and day 7 of life, with 8.7-9.9% experiencing severe IVH
- Intra-amniotic inflammation was associated with 2.47 times higher odds of IVH on day 1
- Epinephrine use during resuscitation was associated with 4.88 times higher odds of IVH on day 1
- Inotrope use during transport increased odds of IVH by 7.85 on day 1 and 9.11 on day 7
- Continuous positive airway pressure during transport was associated with 68% lower odds of IVH on day 1
Limitations
The study is observational and retrospective, so it cannot establish causation and may have unmeasured confounding factors. The cohort is limited to one region in Australia, which may limit generalisability to other settings.
Abstract
Objectives To evaluate maternal, infant and transport factors associated with intraventricular haemorrhage (IVH) in outborn preterm infants <32 weeks' gestation in Western Australia. Design Retrospective cohort study. Setting Newborn emergency transport service of Western Australia (NETS WA). Participants Preterm infants <32 weeks' gestation born outside the tertiary perinatal centre and transported by NETS WA between 2011 and 2021. Exclusions were congenital anomalies, transfer after day 1 of life or death before day 1 cranial ultrasound. Outcomes Outcome was any IVH detected on cranial ultrasound on day 1 and day 7 of life. Perinatal data were analysed comparing infants with and without IVH using bivariate tests and logistic regression to examine differences between these groups. Results IVH occurred in 57/286 (19.9%) on day 1 and 53/275 (19.9%) on day 7; severe IVH occurred in 25/286 (8.7%) and 27/275 (9.9%), respectively. Infants with IVH had lower gestational age and birth weight, greater exposure to intra-amniotic inflammation and less antenatal steroid exposure. In multivariable analyses, intra-amniotic inflammation was associated with increased odds of IVH on day 1 (OR 2.47, 95% CI 1.10 to 5.44). Epinephrine use during resuscitation was associated with higher odds of IVH on day 1 (OR 4.88, 95% CI 1.49 to 17.5). Inotrope use during transport was associated with IVH on day 1 (OR 7.85, 95% CI 1.35 to 54.6) and day 7 (OR 9.11, 95% CI 1.32 to 72.9). Continuous positive airway pressure during transport was associated with lower odds of IVH on day 1 (OR 0.32, 95% CI 0.10 to 0.88). Transport mode, duration and timing intervals were not associated with IVH. Conclusions In outborn preterm infants <32 weeks' gestation, IVH risk was more strongly associated with perinatal factors than transport characteristics. Collaboration across perinatal networks should aim to support optimal management during preterm labour birth.