PRENATAL AND PERINATAL RISK AND PROTECTIVE FACTORS FOR NEONATAL INTRACRANIAL HEMORRHAGE

Objective: To identify prenatal and perinatal risk and protective fact ors for grade III and IV intracranial hemorrhage (ICH) in 4795 singlet on infants (weight, less than or equal to 1500 g). Method: Prenatal an d perinatal risk and protective factors for ICH were examined initiall y by univariate analysis and adjusted for year of birth, followed by m ultivariate logistic regression analysis that adjusted simultaneously for the effects of year of birth and prenatal and perinatal characteri stics. Setting: Seven tertiary care neonatal-perinatal centers. Result s: By univariate analysis, African-American race, prenatal care, older maternal age, hypertension or preeclampsia, antenatal steroid adminis tration, cesarean section delivery, increasing birth weight, increasin g gestational age, and female gender of the infant were protective pre natal or perinatal factors. Antepartum hemorrhage, the presence of lab or, and breech presentation were perinatal factors that were associate d with an increased risk of ICH. By using staged logistic regression, a model of combined prenatal and perinatal characteristics that influe nced grade III and IV ICH was developed. Significant protective factor s against ICH included a complete course of antenatal steroid therapy, African-American maternal race, female gender of the infant, hyperten sion or preeclampsia with no antepartum hemorrhage, increasing gestati onal age, and increasing birth weight. Conclusion: Antenatal steroid a dministration is a therapeutic intervention that is associated with a decreased risk for neonatal grade III and IV ICH.