Causes of intraventricular hemorrhages in extremely premature newborns and features of their early outcomes

The aim. To study the predisposing factors for the development and timing of development of intraventricular hemorrhage (IVH) in extremely premature newborns.Materials and methods. We carried out retrospective analysis of 32 case histories of children born at a gestational age of less than 32 weeks. The children were divided into three groups: group 1 (n = 13) – children death was caused by non-traumatic IVH; group 2 (n = 12) – surviving infants with IVH; group 3 (comparison group; n = 7) – premature infants without IVH. We assessed risk factors for the development of IVH, their severity, and main indicators predisposing to death in newborns of these groups.Results. Children of the group 1 had statistically significantly low values of body weight – 670 [640–860] g (р1–2 = 0.007; р1–3 = 0.012), head circumference – 23 [22–24] cm (р1–2 = 0.008; р1–3 = 0.049), gestational age – 24.5 [23.5–25.5] weeks (р1–2 = 0.002; р1–3 = 0.007). Gender differences were revealed: in the group 1, there were 92.3 % of boys, in the group 2 – 33.3 % (p1–2 = 0.008). Maternal smoking increased the risk of fatal IVH by 3.5 ± 0.15 times, polyhydramnios – by 3.3 ± 0.37 times, chorioamnionitis – by 12.8 ± 0.47 times, placenta previa – by 3.2 ± 0.15 times. In newborns of the group 1, seizures developed on the day 1 of life in 84.6 % (more often than in group 2; p = 0.00001), and shock in the first 3 hours of life was recorded in 46.1 % of cases (р1–2 = 0.034), which increased the risk of death by 4.3 ± 0.47 times. In newborns of group 1, compared with newborns of groups 2 and 3, pulmonary hypertension was more often detected (60.8 [50.1–69.2] mm Hg; p1–2 = 0.028; p1–3 = 0.047).Conclusion. Confirmed infectious diseases in the mother, clinical manifestation of convulsions, pulmonary hypertension, development of multiple organ failure and shock in extremely premature newborns increase the risk of intraventricular hemorrhage and the frequency of deaths.