SHOULD PRETERM INFANTS BORN AFTER 29 WEEKS GESTATION BE SCREENED FOR INTRAVENTRICULAR HEMORRHAGE

Objectives: To determine whether the current incidence of intraventric ular haemorrhage (MH) of grade 2 or more is high enough in preterm inf ants born after 29 weeks gestation to justify the cost of screening wi th ultrasound and to explore clinical indicators for risk of IVH in th e more mature preterm infant. Methods: This cohort study examined the incidence and severity of IVH in 800 preterm infants born between Janu ary 1992 and August 1996, of whom 436 were born after 29 weeks. Demogr aphic and clinical details were collected from a prospectively maintai ned database. The Medicare schedule charge rate for cerebral ultrasoun d was used to calculate costs. Results: 7.1% of preterm babies horn af ter 29 weeks gestation who had routine ultrasound scans had an IVH of grade 2 or 3, no infant had a grade 4 IVH. Two infants had a grade 3 I VH, both of which were symptomatic. IVH was poorly predicted by other clinical criteria. Using the Medicare schedule to estimate costs, dete cting the five grade 2 or 3 IVH cost A$42 000. Conclusions: The incide nce of grade 2-4 IVH is low in infants born after 29 weeks gestation. Screening of this population is expensive and probably not justified. It may be most appropriate to scan these infants only if their conditi on raises concern.