Intraventricular Hemorrhage: A Prospective Evaluation of Etiopathogenesis

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Abstract
In a study population of 151 newborn infants less than 35 weeks gestation, who required intensive care for more than 24 hours, clinical and biochemical factors associated with the presence of intraventricular hemorrhage (IVH) were prospectively evaluated. The diagnosis of IVH was confirmed by computed tomography, ventricular tap, or autopsy. Alveolar rupture was highly correlated with the presence of IVH. Other factors associated with IVH were: hypoxemia, hypercarbia, mechanical ventilation, peak inflation pressure >25 cm H2O, inspiratory to expiratory ratio >1:1, patent ductus arteriosus, bicarbonate administration after the first day of life, volume expansion in the first day of life, hypotension, stages III and IV hyaline membrane disease, and intrauterine growth retardation. Early bicarbonate administration (first day), sodium administration >8 mEq/kg/day, acidosis and birth weight ≤1,200 gm were associated with IVH only in the infants who died with IVH. Factors not associated with IVH were Apgar ≤5 at one and five minutes, birth weight, gestational age, male sex, osmolality ≥300, serum sodium ≥150, hypothermia, continuous distending pressure > 6 cm H2O, positive end-expiratory pressure > 5 cm H2O, outborn birth, obstetric trauma, or coagulopathy. Certain therapeutic interventions may lead to an increase incidence of intracerebral hemorrhage in the high-risk preterm infant.