Intraventricular haemorrhage and stage 3 retinopathy of prematurity

Background/aims-A recent report has highlighted the decreasing prevalence i n recent years of severe intraventricular haemorrhage (IVH) in very low bir thweight (VLBW) infants (<1500 g). This study attempted to identify the sev erity of the grade of IVH in infants with stage 3 retinopathy of prematurit y (ROP), and to re-examine the association between threshold ROP and IVH. Methods-This was a retrospective study carried out over 3 years, between De cember 1995 and December 1998 of neonates admitted to a single neonatal int ensive care unit. 28 infants with stage 3 ROP were identified from the ROP screening database. Cranial ultrasound scans were available on 24 of these infants. The scans were reviewed and the severity of IVH was graded from gr ade 1 to grade 4. The birth weight, sex, ethnic origin, and gestational age of the babies were recorded. The number of infants progressing to threshol d disease and the treatment provided was documented. Results-The 24 infants had a median gestational age of 26 weeks (range 24-2 8 weeks) and a median birth weight of 762.5 g (range 540-1010 g). 17 infant s were treated for threshold disease. 13 infants (54.2%) had IVH, of these eight (61.5%) had grade 1, two (15.4%) had grade 2, one (7.7%) had grade 3, and two (15.4%) had grade 4. 12 of the 13 infants (92.3%) with IVH had tre atment with laser or cryotherapy for ROP compared with five of the remainin g 11 infants (p = 0.023, Fisher's exact test). These data provide little ev idence of any association between IVH and each of ethnic origin (p = 0.856) , sex (p = 1), birth weight, or gestational age (p = 0.56 and p = 0.06 resp ectively) in infants with stage 3 ROP. Conclusions-These data provide strong evidence (p = 0.023) of an associatio n between the presence of IVH and treatment of threshold ROP. Although the numbers in this study are small the majority of infants with stage 3 ROP ha d grade I IVH, which heralds a more favourable neurological outcome. An ass ociation between the severity of ROP and severity of IVH was not demonstrat ed. With improvements in neonatal care and a reduction in the prevalence of severe IVH, there appears to be a weakening of the previously reported ass ociation between severe IVH and severe ROP. However, the presence of even a minor grade of IVH may be a significant risk factor for threshold ROP once stage 3 disease is encountered.