Effect of maternal tocolysis on the incidence of severe periventricular/intraventricular haemorrhage in very low birthweight infants

Aim-To examine the relation between grade III-IV periventricular/intraventr icular haemorrhage (PVH/IVH) and antenatal exposure to tocolytic treatment in very low birthweight (VLBW) premature infants. Study design-The study population consisted of 2794 infants from the Israel National VLBW Infant Database, of gestational age 24-32 weeks, who had a c ranial ultrasound examination during the first 28 days of life. Infants of mothers with pregnancy induced hypertension or those exposed to more than o ne tocolytic drug were excluded. Of the 2794 infants, 2013 (72%) had not be en exposed to tocolysis and 781 (28%) had been exposed to a single tocolyti c agent. To evaluate the effect of tocolysis and confounding variables on g rade III-IV PVH/IVH, the chi (2) test) univariate analysis, and a logistic regression model were used. Results-Of the 781 infants (28%) exposed to tocolysis, 341 (12.2%) were exp osed to magnesium sulphate, 263 (9.4%) to ritodrine, and 177 (6.3%) to indo methacin. The overall incidence of grade III-IV PVH/IVH was 13.4%. In the m ultivariate logistic regression analysis, the following factors were relate d significantly and independently to grade III-IV PVH/IVH: no prenatal ster oid treatment, low gestational age, one minute Apgar score 0-3, respiratory distress syndrome, patent ductus arteriosus, mechanical ventilation, and p neumothorax. Infants exposed to ritodrine tocolysis (but not to the other t ocolytic drugs) were at significantly lower risk of grade III-IV PVH/IVH af ter adjustment for other variables (odds ratio = 0.3; 95% confidence interv al 0.2 to 0.6). Conclusion-This study suggests that antenatal exposure of VLBW infants to r itodrine tocolysis, in contrast with tocolysis induced by magnesium sulphat e or indomethacin, was associated with a lower incidence of grade III-IV PV H/IVH.