Risk factors for neonatal intraventricular haemorrhage in spontaneous prematurity at 32 weeks gestation or less

In this study we aimed to establish which clinical and histopathological fa ctors are associated with early-onset neonatal intraventricular haemorrhage (IVH) in non-iatrogenic preterm delivery before 32 weeks of gestation. We retrospectively reviewed all singleton pregnancies delivered before 32 w eeks of gestation after spontaneous onset of preterm labour or preterm memb rane rupture during the period January 1993 to June 1997. Clinical and hist opathological data in cases with IVH diagnosed at neonatal cranial ultrasou nd within 72 h of birth (n=17) were compared with those of neonates not exp eriencing this complication (non-IVH) (n=54). Histological lesions analysed were those of acute inflammation and those on a uteroplacental vascular ba sis. Statistical methods included the Wilcoxon rank sum test, Fisher's exac t test, and logistic regression analysis. A P<0.05 was considered significa nt. IVH and non-IVH groups were not significantly different. in birthweight, ge stational age at delivery, cord pH at birth, rates of 5-min Apgar score bel ow 7, caesarean delivery, diagnosis of clinical chorioamnionitis or antenat al administration of steroids. Respiratory distress syndrome was more frequ ently diagnosed in the IVH than non-IVH group (64 per cent versus 33 per ce nt, P=0.02). Placental acute inflammatory or uteroplacental vascular lesion s were present in 100 per cent of IVH neonates versus 22 per cent of non-IV H cases (P<0.001). Logistic regression analysis demonstrated that only resp iratory distress syndrome (P=0.04) and histological evidence of acute place ntal inflammation (P=0.02) were significantly and independently associated with IVH. Histopathological evidence of acute inflammatory placental lesions is the b est predictor of occurrence of neonatal IVH. (C) 2000 Harcourt Publishers L td.