Short-term outcomes of very low-birthweight infants with intraventricular haemorrhage who received respiratory support in a middle-income country neonatal unit

Background. Prematurity is a major risk factor for intraventricular haemorrhage (IVH). Premature infants often require respiratory support. There is little information on neonates with IVH on respiratory support in low- and middle-income countries.  Objective. To describe the characteristics and short-term outcomes of very-low-birthweight (VLBW) infants with IVH receiving respiratory support in a tertiary neonatal unit with resource limitations.  Methods. This was a matched retrospective observational study. The population included VLBW infants with IVH, who received positive pressure respiratory support between January 2014 and December 2016. Severe IVH was compared with mild IVH.  Results. One hundred and fifty infants were included in the study; 56 (37%) received continuous positive airway pressure (CPAP) only and 94 (63%) mechanical ventilation. Severe IVH was associated with surfactant therapy across both ventilation groups ( p =0.03). Infants with severe IVH had prolonged oxygen requirements at 28 days (79% v. 38%; p =0.01) (odds ratio (OR) 6.11; 95% confidence interval (CI) 1.19 - 31.34; p =0.03) v. those with mild IVH. Severe IVH and the presence of coagulopathy were the strongest predictors of death in both ventilation groups ( p <0.0001). Pulmonary haemorrhage was the most common cause of death in severe IVH and blood culture-confirmed sepsis in mild IVH. Periventricular leukomalacia (PVL) was associated with severe IVH in invasive ventilation (OR 6.67; 95% CI 1.11 - 40.17).  Conclusion. VLBW infants with severe IVH who are mechanically ventilated or with coagulopathy have a high mortality, with pulmonary haemorrhage being the prominent cause of death. These prognostic factors may assist in end-of-life care in resource-limited settings.