Neonatal and obstetric risk factors are associated with the increased risk of neonatal intracranial hemorrhage

Abstract

Background In newborns, intracranial hemorrhage (ICH) is an acquired lesion with a high risk of morbidity, mortality, and long-term neurodevelopmental outcomes. Despite major improvements in newborn care and greater preterm infant survival in recent decades, ICH remains a serious concern. This study aimed to determine the prevalence of ICH in newborns and the various obstetric and neonatal risk factors linked to ICH development. This case–control study was conducted throughout the period from June 2017 to December 2017. Patients and methods This case–control research involved 240 infants admitted to Cairo University's Obstetrics and Gynecology Hospital's Neonatal Intensive Care Unit (NICU). We took detailed history, such as the maternal, obstetric, and delivery circumstances, laying stress on maternal and obstetric ICH risk factors. The general condition was assessed at 1 and 5 min using the Apgar score. Ballard score was used to determine gestational age. The birth weight was measured. A thorough clinical examination with a focus on neurological evaluation in accordance with the Sarnat phases was performed. The authors used cranial ultrasonography for imaging (CUS). Results Of 240 neonates, 78 neonates developed ICH (32.5%). Overall, 42.9% were males and 21.1% were females. Intraventricular hemorrhage was the commonest one (24.2%), and grade one intraventricular hemorrhage represented 13.4%. The prevalence of asymptomatic cases with ICH was 66.7%. The neonatal risk factors associated with increased ICH risk were prematurity, representing 67.4%; pneumothorax, representing 76.9%; and trauma, representing 77.3%. The sensitivity of CUS for detection of ICH was 84.6%, and the specificity of CUS was higher, representing 97.5%. Overall, 41.03% of ICH cases appeared on the first day of life and 76.9% on the third day by CUS. Conclusion The prevalence of asymptomatic cases with ICH was 66.7%. Certain neonatal risk factors are associated with increased risk of ICH such as birth weight, sex, gestational age, mode of delivery, and obstetric risk factors. CUS can be considered as a specific and sensitive indicator for the occurrence of ICH.

Keywords

• cranial ultrasound
• gestational age
• intracranial hemorrhage
• intraventricular hemorrhage
• neonatal intensive care unit
• premature rupture of membrane