Clinical and anamnestic risk factors for intraventricular hemorrhage in premature newborns: results of a single-center study

Intraventricular hemorrhages (IVH) belong to the group of medical and social problems, as they remain one of the causes of mortality and disability among premature newborns. Identification of risk factors for the development of IVH is an urgent problem and is important in clinical medicine to help doctors conduct early intervention that can improve the survival and quality of life of children.

Objective - to determine the risk factors for the development of IVH in premature infants, based on the analysis of anamnestic, clinical, instrumental and laboratory data.

Materials and methods. In the period from 2023 to 2024, a single-stage observational comparative study was conducted. Data on 70 premature newborns were analyzed. Statistical data processing was carried out using the software package "IBM SPSS Statistics Version 25.0", Microsoft Excel.

Results. The birth weight of children was significantly lower in group 1 (p=0.048). Mothers of infants in the first group had body mass deficiency significantly more often in the 1st group (p=0.011). An analysis of the obstetric and gynecological history showed that mothers of newborns from group 1 were significantly more likely to have: severe preeclampsia (p=0.029); premature detachment of the normally located placenta (p=0,032). IVH developed more frequently with the pathological nature of childbirth and a long anhydrous period (χ²=4.480 p=0.034). Concomitant hemorrhagic syndrome accompanied by hypocoagulation in the coagulogram, as well as protein deficiency, according to biochemical blood analysis, was found in 28.6% of newborns in group 1, which increased the risk of developing IVH by 4,267 times, 95% CI [1,060-17,168].

Conclusion. The study identified risk factors for the development of IVH in premature newborns, which include body weight deficiency in women, progressive placental abruption, severe preeclampsia in mothers, prolonged spontaneous labor and prolonged anhydrous period, concomitant hemorrhagic syndrome (pulmonary, gastrointestinal bleeding, skin hemorrhages).

1. Cerisola A., Baltar F., Ferrán C., Turcatti E. Mecanismos de lesión cerebral en niños prematuros. Medicina (B Aires). 2019;79(3):10-14 [Cerisola A., Baltar F., Ferrán C., Turcatti E. Mechanisms of brain injury of the premature baby. Medicina (B Aires). 2019;79(3):10-14 (in Span.)]

2. Cormack B.E., Harding J.E., Miller S.P., Bloomfield F.H. The Influence of Early Nutrition on Brain Growth and Neurodevelopment in Extremely Preterm Babies: A Narrative Review. Nutrients. 2019;11(9):2029. DOI: 10.3390/nu11092029.

3. Ballabh P., de Vries L.S. White matter injury in infants with intraventricular haemorrhage: mechanisms and therapies. Nat Rev Neurol. 2021;17(4):199-214. DOI: 10.1038/s41582-020-00447-8.

4. Dohare P., Kidwai A., Kaur J., Singla P., Krishna S., Klebe D. Zhang X., Hevner R., Ballabh P. GSK3β Inhibition Restores Impaired Neurogenesis in Preterm Neonates With Intraventricular Hemorrhage. Cereb Cortex. 2019;29(8):3482-3495. DOI: 10.1093/cercor/bhy217.

5. Cheng B., Ballabh P. Recovery of the brain after intraventricular hemorrhage. Semin Fetal Neonatal Med. 2022;27(1):101224. DOI: 10.1016/j.siny.2021.101224.

6. Sharma D.R., Agyemang A., Ballabh P. Cerebral gray matter injuries in infants with intraventricular hemorrhage. Semin Perinatol. 2022;46(5):151595. DOI: 10.1016/j.semperi.2022.151595.

7. Klebe D., McBride D., Krafft P.R., Flores J.J., Tang J., Zhang J.H. Posthemorrhagic hydrocephalus development after germinal matrix hemorrhage: Established mechanisms and proposed pathways. J Neurosci Res. 2020;98(1):105-120. DOI: 10.1002/jnr.24394.

8. Intraventricular non-traumatic hemorrhage in the fetus and newborn: Draft federal clinical guidelines. The Russian Society of Neonatologists is an all-Russian public organization for the Promotion of neonatology. The Russian Association of Perinatal Medicine Specialists (RASM). Association of Specialists in the Field of Perinatal Medicine, assistance to Pregnant Women and Fetuses, Newborns and Children under 3 Years of Age (ASPM+). Moscow; 2023:70 (in Russ.).

9. Mudrov, V. A. Algorithms for statistical analysis of qualitative features in biomedical research using the SPSS software package. Zabajkalʹskij medicinskij vestnik. 2020;1:151-163 (in Russ). DOI: 10.52485/19986173_2020_1_151. EDN: OCWGOH.

10. Yeo K.T., Thomas R., Chow S.S., Bolisetty S., Haslam R., Tarnow-Mordi W. Lui K. Improving incidence trends of severe intraventricular haemorrhages in preterm infants №32 weeks gestation: a cohort study. Arch Dis Child Fetal Neonatal Ed. 2020;105(2):145-150. DOI: 10.1136/archdischild-2018-316664.

11. Maduray T., Mamdoo F., Masekela R. A retrospective study on the prevalence, severity and outcomes of intraventricular haemorrhage in infants with a low birth weight in a quarternary hospital in a low- to middle-income country. South African Journal of Child Health. 2019;13(2):56-62. DOI: 10.7196/SAJCH.2019.v13i2.1529.

12. Leijser L.M., de Vries L.S. Preterm brain injury: Germinal matrix-intraventricular hemorrhage and post-hemorrhagic ventricular dilatation. Handb Clin Neurol. 2019;162:173-199. DOI: 10.1016/B978-0-444-64029-1.00008-4.

13. Kocherova V.V., Popova N.G., Shherbak V.A. The causes of intraventricular hemorrhages in deeply premature newborns and the features of their early outcomes. Acta Biomedica Scientifica. 2024;9(3):179-187 (in Russ). DOI: 10.29413/ABS.2024-9.3.18. EDN: RZDUQV.

14. Akuamoah-Boateng G., Moon T.D., Amorim G., Bandini R., Ballot D.Intraventricular hemorrhage among very low birth weight infants in a South African cohort: a retrospective study of trends & short-term outcomes. BMC Pediatr. 2025;25(1):138. DOI: 10.1186/s12887-025-05426-w.

15. Farghaly M.A.A., Aziz H.F., Puthuraya S., Abdalla A., Aly H., Mohamed M.A. Placental abruption and risk for intraventricular hemorrhage in very low birth weight infants: the United States national inpatient database. J Perinatol. 2024;44(10):1504-1508. DOI: 10.1038/s41372-024-02017-y.

16. Harlamova N.V., Chasha T.V., Panova I.A., Rokotjanskaja E.A., Shilova N.A., Anan'eva M.A. The state of health of newborns born to mothers with hypertensive disorders during pregnancy. Vestnik Ivanovskoj medicinskoj akademii. 2017;(3):19-23 (in Russ). EDN: YLNMTX.

17. Gamaleldin I., Harding D., Siassakos D., Draycott T., Odd D. Significant intraventricular hemorrhage is more likely in very preterm infants born by vaginal delivery: a multi-centre retrospective cohort study. J Matern Fetal Neonatal Med. 2019;32(3):477-482. DOI: 10.1080/14767058.2017.1383980.

18. Costa S.T.B., Costa P., Graça A.M., Abrantes M. Portuguese National Registry of very low birth weight infants. Delivery Mode and Neurological Complications in Very Low Birth Weight Infants. Am J Perinatol. 2024;41(9):1238-1244. DOI: 10.1055/a-1815-1842.

19. Kirtbaja A.R., Ionov O.V., Balashova E.N., Sharafutdinova D.R., Golubcova Ju.M., Suvorova D.Ju. et al. Coagulation risk factors for the development and progression of intraventricular hemorrhages in premature infants in the early neonatal period. Neonatologija: novosti, mnenija, obuchenie. 2024;12(3):31-39 (in Russ). DOI: 10.33029/2308-2402-2024-12-3-31-39. EDN: LDOYXL.

20. Khanafer-Larocque I., Soraisham A., Stritzke A., Al Awad E., Thomas S., Murthy P., Kamaluddeen M., Scott J.N., Mohammad K.Intraventricular Hemorrhage: Risk Factors and Association With Patent Ductus Arteriosus Treatment in Extremely Preterm Neonates. Front Pediatr. 2019;22(7):408. DOI: 10.3389/fped.2019.00408.

21. Huang W.H., Li D.M., Hsu C.T., Lin Y.H., Hsu Y.C., Wang T.M., Lin M.C. Decreased Incidence of Intraventricular Hemorrhage in Extremely Low Birth Weight Infants Using Customized Circulatory Management to Evaluate the Hemodynamic Change of Patent Ductus Arteriosus. Front Pediatr. 2021;30(9):711871. DOI: 10.3389/fped.2021.711871.