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 is one of the first studies of IVH in LBW neonates in a LIC in sub-Saharan Africa and the first in east Africa.
Objectives The objective of this study is 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. The aOR for having any IVH was 3.5 (95% CI 1.01–16.45), comparing vaginal delivery with Caesarean delivery. Compared with neonates of ≥32 weeks GA, neonates of GA < 32 weeks had increased odds of any IVH, aOR 6.70 (95% CI 1.6–31.02), high grade IVH, aOR 8.18 (95% CI 1.18–69.37), and low grade IVH, aOR 6.70 (95% CI 1.12–46.9). Neonates who required resuscitation in the NU also had increased odds of any IVH, aOR 5.10 (95% CI 1.23–26.36) and high grade IVH aOR 9.24 (95% CI 1.83–54.38). Neonates who were SGA (small for gestational age, <10th centile) had increased odds of low grade IVH, aOR 9.96 (95% CI 1.83–71.84). Of the 6 neonates who received 2 doses of antenatal steroids, none had IVH.
Conclusions This study found that in this resource limited NU in a regional referral hospital in eastern Uganda, more than a third of neonates born weighing ≤2000 g had an IVH and majority of these occurred by day 7. We found that vaginal delivery, GA < 32 weeks, resuscitation in the NU and being SGA were associated with increased odds of having an IVH. This study had a high rate of SGA neonates and the risk factors and relationship of these with IVH in this setting needs further investigation. The role of antenatal steroids in the prevention of IVH in LICs also needs urgent exploration.
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