Peri/intraventricular haemorrhage: a cranial ultrasound study on 5286 neonates


      Objective: We launched a prospective cranial ultrasound study at the Department of Obstetrics and Gynaecology of the University of Giessen. In this study we examined the incidence and severity of brain damage in neonates and related them to various obstetrical risk factors. Study design: More than 90% of all neonates born between 1984 and 1988 were included in the study (n=5286) and were screened by ultrasound for cerebral abnormalities on 5–8 days post-partum. The relation between the incidence of peri/intraventricular haemorrhages (PIVH) and obstetrical risk factors were analyzed by contingency tables. Results: The most frequent abnormality was PIVH (3.6%) of various degrees (grade I–III). Periventricular leucomalacia, porencephalia, subarachnoidal haemorrhages, and hydrocephali were rare (≤0.2%). The incidence of PIVH increased progressively with decreasing gestational age, e.g. from 1.6% at 38–43 weeks up to 50.0% at 24–30 weeks of gestation. A large percentage of babies with PIVH were clinically normal. In immature neonates there was a close inverse relationship between Apgar score at 1, 5 and 10 min and both incidence and severity of PIVH. This was in contrast to findings in mature neonates where a marked increase in the incidence of PIVH was found only with Apgar scores as low as 0–4 points. The relation between the incidence of PIVH and both cardiotocography and arterial cord blood pH was poor, independent of the gestational age. The incidence of PIVH was increased in growth retarded fetuses (pH≤7.29), premature rupture of membranes, fever sub partu and gestosis. It is interesting to note that in mature fetuses there was no difference in the incidence of PIVH between vaginally delivered (0.8%) and sectioned breech presentations (2.1%). In preterms at 35–37 weeks with prolonged labour and secondary cesarean section, the incidence of PIVH was very high (11.2%). Conclusion: From the present study we conclude that the incidence of PIVH especially in immature neonates is highly associated with low Apgar scores at birth. Since the Apgar score reflects the clinical condition and the degree of circulatory centralisation of neonates that is influenced by various ante- and intranatal risk factors, a protective obstetrical management is necessary to reduce the incidence of PIVH in neonates.


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        • Lazarrra A
        • Ahman P
        • Dykes F
        • Brann AW
        • Schwartz J
        Clinical predictability of intraventricular hemorrhage in preterm infants.
        Pediatrics. 1980; 65: 30-34
        • Wille L
        • Keller U
        • Dillenz M
        • Stenzel K
        Zur Frühprognose der intrakraniellen Blutung bei Frühgeborenen.
        Monatsschr Kinderheilk. 1986; 134: 422-427
        • Ment LR
        • Oh W
        • Philip AGS
        • Ehrenkranz RA
        • Duncan CC
        • Allan W
        • Taylor KJW
        • Schneider K
        • Katz KH
        • Makuch RW
        Risk factors for early intraventricular hemorrhage in low birth weight infants.
        J Pediatr. 1992; 121: 776-783
        • Burrus DR
        • O'Shea TM
        • Veille J-C
        • Müller-Heubach E
        The predictive value of intrapartum fetal heart rate abnormalities in the extremely premature infant.
        Am J Obstet Gynecol. 1994; 171: 1128-1132
        • Beeby PJ
        • Elliot EJ
        • Henderson-Smart DJ
        • Rieger ID
        Predictive value of umbilical artery pH in preterm infants.
        Arch Dis Child. 1994; 71: F93-96
        • Spinillo A
        • Ometto A
        • Bottino R
        • Piazzi G
        • Iasci A
        • Rondini G
        Antenatal risk factors for germinal matrix hemorrhage and intraventricular hemorrhage in preterm infants.
        Eur J Obstet Gynecol Reprod Biol. 1995; 60: 13-19
        • Jensen A
        • Klingmüller V
        • Künzel W
        • Sefkow S
        Das Hirnblutungsrisiko bei Früh- und Reifgeborenen.
        Geburtsh u Frauenheilk. 1992; 52: 6-20
        • Shankaran S
        • Slovis TL
        • Bedard MP
        • Poland RL
        Sonographic classification of intraventricular hemorrhage. A prognostic indicator of mortality, morbidity, and short-term neurologic outcome.
        J Pediatr. 1982; 100: 469-475
        • Papile L-A
        • Burstein J
        • Burstein R
        • Koffler H
        Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weight less than 1500 g.
        J Pediatr. 1978; 92: 529-534
        • Levene MI
        • Strate DR
        A longitudinal study of post-haemorrhagic ventricular dilatation in the newborn.
        Arch Dis Child. 1981; 56: 905-910
        • Donn SM
        • Stuck KJ
        Neonatal germinal matrix hemorrhage: evidence of a progressive lesion.
        J Pediatr. 1981; 99: 459-461
        • Lou HC
        Perinatal hypoxic-ischemic brain damage and intraventricular hemorrhage.
        Arch Neurol. 1980; 37: 585-587
        • Allan WC
        • Volpe JJ
        Periventricular intraventricular hemorrhage.
        Pediatr Clin North Am. 1986; 36: 47-63
      1. Milligan DWA. Failure of autoregulation and intraventricular hemorrhage in preterm infants. Lancet 1980:896–898.

        • Haruda FWA
        • Blanc A
        The structure of intracranial arteries in premature infants and the autoregulation of cerebral blood flow.
        Ann Neurol. 1981; 10: 303
        • Levene MI
        • Fawer CL
        • Lamont RF
        Risk factors in the development of intraventricular haemorrhage in the preterm neonate.
        Arch Dis Child. 1982; 57: 410-417
        • Burstein J
        • Papile LA
        • Burstein R
        Intraventricular hemorrhage and hydrocephalus in premature newborns: a prospective study with CT.
        Am J Roentgenol. 1979; 132: 631-635
        • Donn SM
        • Roloff DW
        • Goldstein GW
        Prevention of intraventricular hemorrhage in preterm infants by pentobarbitone.
        Lancet. 1981; 2: 215-217
        • Flodmark O
        • Fritz CR
        • Harwood-Nash DC
        CT diagnosis and short-term prognosis of intracranial hemorrhage and hypoxic/ischemic brain damage in neonates.
        J Comput Assist Tomogr. 1980; 4: 775-787
        • Shinnar S
        • Molteni RA
        • Gammon H
        • D'Souza BJ
        • Altman J
        • Freeman JM
        Intraventricular hemorrhage in the premature infant.
        N Engl J Med. 1982; 306: 1464-1468
        • Eilers BL
        • Desai NS
        • Wilson MA
        • Cunningham MD
        Classroom performance and social factors of children with birth weights of 1250 g or less: follow-up at 5 to 8 years of age.
        Pediatrics. 1986; 177: 203-208
        • Berverly DW
        • Chance G
        Cord blood gases, birth asphyxia, and intracranial haemorrhage.
        Arch Dis Child. 1984; 59: 884-886
        • Jensen A
        • Berger R
        Fetal circulatory responses to oxygen lack.
        J Dev Physiol. 1991; 16: 181-207
        • Dijxhoorn MJ
        • Visser GH
        • Fidler AVJ
        • Touwen BCL
        • Huisjes HJ
        Apgar score, meconium, and acidemia at birth in relation to neonatal morbidity in term infants.
        Br J Obstet Gynecol. 1986; 93: 217-222
        • Iwamoto HS
        • Kaufman T
        • Keil LC
        • Rudolph AM
        Responses to acute hypoxemia in the fetal sheep at 0.6–0.7 gestation.
        Am J Physiol. 1989; 256: H613-620
      2. Jensen A, Lang U, Braems G. Endotoxinschock des Feten verhindert Kreislaufzentralisation bei Asphyxie. Akademische Tagung deutschsprechender Hochschullehrer in der Gynäkologie und Geburtshilfe. Abstraktband 1989:89.

        • Robinson JS
        • Jones CT
        • Kingston EJ
        Studies on experimental growth retardation in sheep. The effects of maternal hypoxaemia.
        J Dev Physiol. 1983; 5: 89-100
        • Brockerhoff P
        • Brand M
        • Ludwig B
        Untersuchungen zur Häufigkeit perinataler Hirnblutungen und deren Abhängigkeit vom Geburtsverlauf mit Hilfe der cranialen Computertomographie.
        Geburtsh u Frauenheilk. 1981; 41: 597-600
        • Kubli S
        • Rüttgers H
        • Meyer-Menk M
        Die fetale Azidosegefährdung bei vaginaler Geburt aus Beckenendlage.
        Z Geburtsh u Perinat. 1975; 179: 1
      3. Künzel W, Hahn A, Kirschbaum M. Die Entbindung aus Beckenendlage-Ist die generelle Sectio gerechtfertigt? In Künzel W, Kirschbaum M, editors. Gießener Gynäkologische Fortbildung. Berlin: Springer Verlag, 1989, pp. 50–64.

        • Geirsson RT
        • Namunkaugula R
        • Calder AA
        • Lunan CB
        Preterm singleton breech presentation: the impact of traumatic intracranial haemorrhage on neonatal morbidity.
        J Obstet Gynecol. 1982; 2: 219
        • Künzel W
        Sectio bei Beckenendlage aus Sicherheit oder aus Furcht vor Komplikationen?.
        Gynäkologe. 1989; 22: 205-210
        • Evelbauer K
        Der Vakuumextraktor im klinisch-praktischen Gebrauch.
        Geburtsh u Frauenheilk. 1956; 16: 223