INTRACEREBRAL HEMORRHAGES IN PRETERM INFA NTS - INCIDENCE AND PERINATAL RISK-FACTORS

Aim of the study: The survival rate among very small premature infants has increased dramatically over the last few years. However, intracra nial haemorrhages remain a serious problem. In this study we investiga ted the influence of various perinatal risk factors on the incidence o f intracranial haemorrhage. Methods: We analyzed the clinical records of all premature infants (n = 1109) with a gestational age of less tha n 34 weeks and/or a birth weight < 1500 g admitted immediately postnat ally to our unit be tween 1980 and 1990. Infants with letal malformati ons were excluded from the study, A multiple logistic regression appro ach was used for the risk factor analysis. Results: During the study p eriod we observed a decrease in the incidence of intracranial haemorrh age from 44% (1985/86) to 24% (1989/90) in infants less than or equal to 1000 g, from 26% to 21% between 1001 and 1250 g and from 18% to 7% in the weight group from 1251 to 1500 g. Using multiple logistic regre ssion with adjustment for 4 predefined variables (gestational age, yea r of birth, sex, respiratory distress syndrome) we could identify the following risk factors predictive of intracranial haemorrhage: low ges tational age, absence of a paediatrician at birth, Apgar values < 7, u mbilical artery cord pH less than or equal to 7.25, duration of transp ort > 30 min. In addition, hypothermia less than or equal to 36 degree s C, haemoglobin concentration less than or equal to 14 g/dl, base exc ess less than or equal to -6 mval/l, pH value less than or equal to 7. 15 on admission to the neonatal intensive care unit and the occurrence of septicemia, respiratory distress syndrome? pulmonary interstitial emphysema or pneumothorax were associated with an increased risk for i ntracranial haemorrhage. Infants less than or equal to 1500 g born out side the perinatal centre or infants less than or equal to 1500 g born by vaginal delivery had a significantly increased risk to develop int racranial haemorrhage. Conclusions: Centralization of high risk pregna ncies in perinatal centres and improved standards of perinatal care ma y further reduce the incidence of intracranial haemorrhage in preterm infants. Our data seem to favour the use of Caesarian section in very small premature newborn infants.