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      Intraventricular haemorrhage in a Ugandan cohort of low birth weight neonates: the IVHU study

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          Abstract

          Background

          Globally, 15 million neonates are born prematurely every year, over half in low income countries (LICs). Premature and low birth weight neonates have a higher risk of intraventricular haemorrhage (IVH). There are minimal data regarding IVH in sub-Saharan Africa. This study aimed to examine the incidence, severity and timing of and modifiable risk factors for IVH amongst low-birth-weight neonates in Uganda.

          Methods

          This is a prospective cohort study of neonates with birthweights of ≤2000 g admitted to a neonatal unit (NU) in a regional referral hospital in eastern Uganda. Maternal data were collected from interviews and medical records. Neonates had cranial ultrasound (cUS) scans on the day of recruitment and days 3, 7 and 28 after birth. Risk factors were tabulated and are presented alongside odds ratios (ORs) and adjusted odds ratios (aORs) for IVH incidence. Outcomes included incidence, timing and severity of IVH and 28-day survival.

          Results

          Overall, 120 neonates were recruited. IVH was reported in 34.2% of neonates; 19.2% had low grade (Papile grades 1–2) and 15% had high grade (Papile grades 3–4). Almost all IVH (90.2%) occurred by day 7, including 88.9% of high grade IVH. Of those with known outcomes, 70.4% (81/115) were alive on day 28 and survival was not associated with IVH. We found that vaginal delivery, gestational age (GA) < 32 weeks and resuscitation in the NU increased the odds of IVH. Of the 6 neonates who received 2 doses of antenatal steroids, none had IVH.

          Conclusion

          In this resource limited NU in eastern Uganda, more than a third of neonates born weighing ≤2000 g had an IVH and the majority of these occurred by day 7. We found that vaginal birth, earlier gestation and need for resuscitation after admission to the NU increased the risk of IVH. This study had a high rate of SGA neonates and the risk factors and relationship of these factors with IVH in this setting needs further investigation. The role of antenatal steroids in the prevention of IVH in LICs also needs urgent exploration.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12887-020-02464-4.

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          Most cited references37

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          Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012.

          Extremely preterm infants contribute disproportionately to neonatal morbidity and mortality.
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            Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network.

            This report presents data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network on care of and morbidity and mortality rates for very low birth weight infants, according to gestational age (GA). Perinatal/neonatal data were collected for 9575 infants of extremely low GA (22-28 weeks) and very low birth weight (401-1500 g) who were born at network centers between January 1, 2003, and December 31, 2007. Rates of survival to discharge increased with increasing GA (6% at 22 weeks and 92% at 28 weeks); 1060 infants died at or=24 weeks survive, high rates of morbidity among survivors continue to be observed.
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              Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm.

              We have performed brain scanning by computed tomography on 46 consecutive live-born infants whose birth weights were less than 1,500 gm; 20 of them had evidence of cerebral intraventricular hemorrhage. Nine of the 29 infants who survived had IVH. Four grades of IVH were identified. Grade I and II lesions resolved spontaneously, but there was prominence of the interhemispheric fissue on CT of the infants at six months of age. Hydrocephalus developed in infants with Grade III and IV lesions. Seven of the surviving infants with IVH did not have clinical evidence of hemorrhage. There were no significant differences between the infants with and without IVH in birth weight, gestational age, one- and five-minute Apgar scores, or the need for resuscitation at birth or for subsequent respiratory assistance.
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                Author and article information

                Contributors
                kathy.burgoine@gmail.com
                Journal
                BMC Pediatr
                BMC Pediatr
                BMC Pediatrics
                BioMed Central (London )
                1471-2431
                6 January 2021
                6 January 2021
                2021
                : 21
                : 12
                Affiliations
                [1 ]GRID grid.461221.2, ISNI 0000 0004 0512 5005, Neonatal Unit, Mbale Regional Referral Hospital, ; P.O. Box 1966, Mbale, Uganda
                [2 ]GRID grid.418158.1, ISNI 0000 0004 0534 4718, Department of Biostatistics, , Product Development, Genentech, Inc., ; South San Francisco, California USA
                [3 ]Varimetrics Group Limited, P. O Box 2190, Mbale, Uganda
                [4 ]GRID grid.7445.2, ISNI 0000 0001 2113 8111, Department of Paediatrics, , Imperial College London, ; London, UK
                [5 ]GRID grid.8991.9, ISNI 0000 0004 0425 469X, Department of Infectious Disease Epidemiology, , London School of Hygiene & Tropical Medicine, ; Keppel Street, London, UK
                [6 ]GRID grid.415861.f, ISNI 0000 0004 1790 6116, MRC/UVRI & LSHTM Uganda Research Unit, ; PO Box 149, Entebbe, Uganda
                [7 ]GRID grid.52996.31, ISNI 0000 0000 8937 2257, Neonatal Medicine, , University College London Hospitals NHS Trust, ; 235 Euston Road, London, UK
                [8 ]GRID grid.412341.1, ISNI 0000 0001 0726 4330, Department of Neonatology and Pediatric Intensive Care, , Children’s University Hospital of Zurich, ; Zurich, Switzerland
                [9 ]GRID grid.412341.1, ISNI 0000 0001 0726 4330, Children’s Research Center, , University Children’s Hospital Zurich, ; Zurich, Switzerland
                Author information
                http://orcid.org/0000-0001-7975-745X
                Article
                2464
                10.1186/s12887-020-02464-4
                7786968
                33407279
                a2f62708-a18a-4ccd-8339-6ab5c2078e1b
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 7 July 2020
                : 10 December 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000862, Sir Halley Stewart Trust;
                Award ID: 1825
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2021

                Pediatrics
                intraventricular haemorrhage,preterm,low birth weight,neonate,low income country
                Pediatrics
                intraventricular haemorrhage, preterm, low birth weight, neonate, low income country

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