Intraventricular hemorrhage in preterm neonates: clinical predictors and outcomes

Abstract

Relevance: Intraventricular hemorrhage (IVH) in newborns remains one of the most severe forms of perinatal injury to the central nervous system, associated with high mortality, disability, and unfavorable long-term neurological outcomes. The reported incidence of IVH among all newborns ranges from 0.5% to 2.0%, whereas among extremely preterm infants it reaches 20–40%, particularly in those with a gestational age of less than 32 weeks.

The study aimed to analyze perinatal risk factors, the structure of morbidity, the severity of the clinical course, and the outcomes of intraventricular hemorrhage (IVH) in preterm infants born from January to December 2025 at the Center of Perinatology and Pediatric Cardiac Surgery in Almaty.

Materials and Methods: The study included 100 newborns who received treatment at the Perinatology and Pediatric Cardiac Surgery Center in Almaty. Depending on the presence of IVH, all patients were divided into two groups: group I (main group) — preterm newborns with IVH confirmed by neurosonography (NSG) (n = 32); group II (control group) — preterm newborns without signs of IVH according to NSG data. (n = 68). Perinatal data, antenatal risk factors, laboratory parameters, the structure of concomitant pathology, the nature of intensive therapy, and outcomes were assessed. Statistical analysis was performed using SPSS Statistics 25. Quantitative variables were preliminarily assessed for normality using the Shapiro–Wilk test. An odds ratio (OR) analysis of adverse outcomes was conducted.

Results: The presence of IVH was significantly associated with lower gestational age (31.0  ±  3.1 vs. 33.2  ±  2.4 weeks), lower birth weight (1480  ±  860 vs. 2150  ±  740 g), and lower Apgar scores (p < 0.001). In Group I, neonatal sepsis (50.0% vs. 16.2%), necrotizing enterocolitis (NEC) (28.1% vs. 7.4%), disseminated intravascular coagulation (DIC) syndrome (37.5% vs. 8.8%), anemia (81.3% vs. 47.1%), and bronchopulmonary dysplasia (37.5% vs. 10.3%) were more frequently observed. Mortality in newborns with IVH was 15.6% compared to 1.5% in the group without IVH (p=0.0003). The odds ratio for a fatal outcome was 12.42.

Conclusion: IVH in preterm newborns is associated with lower gestational age, low birth weight, severe condition at birth, and a higher frequency of complications. The presence of IVH is accompanied by an increased risk of adverse outcomes, including mortality, highlighting the importance of early identification of risk factors and timely neurosonographic monitoring.