PERIVENTRICULAR HEMORRHAGE IN VERY-LOW-BIRTH-WEIGHT MALAYSIAN NEONATES

A prospective study was carried out to determine the incidence, clinic al presentation, early outcome, and risk factors associated with periv entricular haemorrhage (PVH) in 88 (84 per cent) of the 105 consecutiv e very low birth weight (VLBW) (< 1500 g) Malaysian neonates born in t he Maternity Hospital, Kuala Lumpur. Based on the cranial ultrasound f indings, PVH was detected in 86 of the 88 neonates (98 per cent, 95 pe r cent confidence intervals: 95 to 101). Seventeen (20 per cent) of th em had grade I, 52 (61 per cent) had grade II, 7 (8 per cent) had grad e III and 10 (12 per cent) had grade IV PVH. PVH was detected in all t he affected neonates by the fifth day of life. Sixty-four neonates (74 per cent) were symptomatic when PVH was first detected. Shock (P < 0. 01), pallor (P = 0.028), low haematocrit of less than 40 per cent (P < 0.01), convulsion (P < 0.001), and bulging of anterior fontanelle (P = 0.01 9) were significantly more common in the neonates with severe P VH (grades III or IV). Death occurred in 43/86 (50 per cent, 95 per ce nt confidence interval: 39-61 per cent) of the neonates with PVH befor e their first discharge from the hospital. Ventriculomegaly developed in 29/43 (67 per cent, 95 per cent confidence intervals: 54.4-81.4) of the survivors with PVH. Our study suggests that PVH is a common probl em in the Malaysian VLBW neonates. To reduce the incidence and severit y of this condition, prevention of preterm delivery and improvement in the basic facilities for neonatal care would help.