ANTENATAL RISK-FACTORS FOR GERMINAL MATRIX HEMORRHAGE AND INTRAVENTRICULAR HEMORRHAGE IN PRETERM INFANTS

Objectives: This study was designed to evaluate the effect of antenata l risk factors on the occurrence of germinal matrix hemorrhage or intr aventricular hemorrhage in preterm infants. Study design: Antenatal fa ctors were evaluated in 302 infants delivered between 24 nd 33 complet ed weeks gestation. Ultrasonographic screening of intracranial hemorrh age was carried out in all the infants. The association between risk f actors and neonatal intracranial hemorrhage was evaluated with both un ivariate and multivariate models. Results: In stepwise logistic regres sion analysis, birthweight was a better predictor of neonatal germinal matrix hemorrhage than gestational age. Conversely, gestational age b etter predicted intraventricular hemorrhage than did birthweight. Risk factors for neonatal germinal matrix hemorrhage and intraventricular hemorrhage were dissimilar. A history of heavy (> 10 cigarettes/day) m aternal smoking on admission increased the risk of germinal matrix hem orrhage three-fold (odds ratio = 3.35; 95% C.I. 1.24-9.07). Antenatal corticosteroid use reduced the risk of intraventricular hemorrhage by 76% (odds ratio = 0.24; 95% C.I. 0.09-0.61). Among patients with spont aneous preterm delivery or premature rupture of fetal membranes, the p resence of labor was a significant effect modifier of the gestational- age associated risk of germinal matrix hemorrhage-intraventricular hem orrhage. Conclusions: Risk factors for neonatal germinal matrix hemorr hage are different from those for intraventricular hemorrhage. Most an tenatal factors, especially those affecting fetal maturity, could infl uence the progression rather than the onset of intracranial hemorrhage .