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Interdisciplinary surveillance of intraventricular haemorrhage associated conditions in infants <1000 g


Obladen, M; Metze, B; Henrich, W; Aktas, A; Czernik, C; Schulz-Baldes, A (2008). Interdisciplinary surveillance of intraventricular haemorrhage associated conditions in infants <1000 g. Acta Paediatrica, 97(6):731-737.

Abstract

AIM: Intraventricular haemorrhage (IVH) causes some of the most adverse outcomes in infants with birthweight <1000 g. Incomplete antenatal steroids, acidosis, inflammation, postnatal transfer, delayed surfactant administration, hypothermia, hypotension, hypocapnia, persistent ductus arteriosus and pneumothorax are all associated with IVH. We hypothesized that prospective surveillance of these IVH-associated conditions decreases their frequency and thus the frequency of IVH. METHODS: Cranial ultrasound was performed on days 1, 3, 7, 30 after birth and at discharge, and was assessed according to Papile. The incidence of IVH and IVH-associated conditions was monitored prospectively in all infants <1000 g born in our perinatal centre in 2005/2006, and obstetricians and neonatologists held monthly interdisciplinary review conferences to discuss the preventability of IVH-associated conditions (IVH surveillance). These data were compared to existing prospective data gathered during routine monitoring in 2004. RESULTS: IVH (all grades) occurred in 29/86 extremely low birthweight (ELBW) infants during routine monitoring and in 12/89 ELBW infants during IVH surveillance (p = 0.007). IVH grades 3-4 dropped from 20% to 3.4% (p = 0.0006). There were significant differences in completeness of antenatal steroids (54% vs. 67%, p = 0.04) and timeliness in initial surfactant substitution (45% vs. 71%, p = 0.01). Most other IVH-associated conditions were reduced during IVH surveillance without reaching significance. CONCLUSIONS: IVH is not always an inevitable disaster. Obstetricians and neonatologists can reduce its incidence by joint prospective surveillance of IVH-associated conditions.

AIM: Intraventricular haemorrhage (IVH) causes some of the most adverse outcomes in infants with birthweight <1000 g. Incomplete antenatal steroids, acidosis, inflammation, postnatal transfer, delayed surfactant administration, hypothermia, hypotension, hypocapnia, persistent ductus arteriosus and pneumothorax are all associated with IVH. We hypothesized that prospective surveillance of these IVH-associated conditions decreases their frequency and thus the frequency of IVH. METHODS: Cranial ultrasound was performed on days 1, 3, 7, 30 after birth and at discharge, and was assessed according to Papile. The incidence of IVH and IVH-associated conditions was monitored prospectively in all infants <1000 g born in our perinatal centre in 2005/2006, and obstetricians and neonatologists held monthly interdisciplinary review conferences to discuss the preventability of IVH-associated conditions (IVH surveillance). These data were compared to existing prospective data gathered during routine monitoring in 2004. RESULTS: IVH (all grades) occurred in 29/86 extremely low birthweight (ELBW) infants during routine monitoring and in 12/89 ELBW infants during IVH surveillance (p = 0.007). IVH grades 3-4 dropped from 20% to 3.4% (p = 0.0006). There were significant differences in completeness of antenatal steroids (54% vs. 67%, p = 0.04) and timeliness in initial surfactant substitution (45% vs. 71%, p = 0.01). Most other IVH-associated conditions were reduced during IVH surveillance without reaching significance. CONCLUSIONS: IVH is not always an inevitable disaster. Obstetricians and neonatologists can reduce its incidence by joint prospective surveillance of IVH-associated conditions.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Institute of Biomedical Ethics and History of Medicine
01 Faculty of Theology > Center for Ethics
Dewey Decimal Classification:170 Ethics
610 Medicine & health
Language:English
Date:June 2008
Deposited On:05 Nov 2008 17:02
Last Modified:05 Apr 2016 12:28
Publisher:Wiley-Blackwell
ISSN:0803-5253
Publisher DOI:10.1111/j.1651-2227.2008.00812.x
PubMed ID:18460106
Permanent URL: http://doi.org/10.5167/uzh-3907

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