IS THE FETAL BRAIN-SPARING EFFECT A RISK FACTOR FOR THE DEVELOPMENT OF INTRAVENTRICULAR HEMORRHAGE IN THE PRETERM INFANT

The intrauterine identification of fetuses at risk of developing intra ventricular hemorrhage would be helpful to the perinatologist, in ligh t of the recent results which suggest that indomethacin given to the i nfant reduces the risk of developing intraventricular hemorrhage. We h ypothesized that fetuses undergoing brain sparing, as identified by a lowered pulsatility index (PI) in the middle cerebral artery, and deli vered prior to 34 weeks may differ in terms of being at risk for intra ventricular hemorrhage from those fetuses without the brain-sparing ef fect. The middle cerebral artery PI was studied in 43 fetuses between 25 and 33.6 weeks' gestation. The pregnancies were complicated by pre- eclampsia, intrauterine growth restriction (IUGR) and preterm labor. A cranial sonogram was performed during the first postnatal week in all the neonates. Intraventricular hemorrhage was present in 6/22 infants with a normal middle cerebral artery PI (group A) and 0/21 with an ab normal middle cerebral artery PI (group B) (p < 0.05). The mothers of the six fetuses who developed intraventricular hemorrhage underwent pr eterm labor. IUGR fetuses and pre-eclampsia were more common in group B. No difference was found between the two groups when the following v ariables were compared: (1) gestational age at the time of the Doppler study; (2) gestational age at delivery; (3) antenatal exposure to ste roids; (4) antenatal exposure to magnesium; (5) Apgar score greater th an 6 at 5 min; (6) respiratory distress syndrome in the newborn; (7) n ecrotizing enterocolitis; (8) Cesarean section; and (9) sepsis in the infant. Although the mean birth weight was significantly lower in grou p B than group A, no fetus in this group developed intraventricular he morrhage. The fetal brain-sparing effect, pre-eclampsia and IUGR were associated with a lower risk of neonatal intraventricular hemorrhage t han was preterm labor. Preterm labor appears to be a key factor in the development of intraventricular hemorrhage and must be included when testing associations with intraventricular hemorrhage.