INTRAKRANIALE BLUTUNGEN BEI FRUHGEBORENEN - INZIDENZ UND PERINATALE RISIKOFAKTOREN

Aim of the study. The survival rate among very small premature infants has increased dramatically over the last few years. However, intracranial haemorrhages remain a serious problem. In this study we investigated the influence of various perinatal risk factors on the incidence of intracranial haemorrhage. Methods. We analyzed the clinical records of all premature infants (n = 1109) with a gestational age of less than 34 weeks and/or a birth weight < 1500 g admitted immediately postnatally to our unit between 1980 and 1990. Infants with lethal malformations were excluded from the study. A multiple logistic regression approach was used for the risk factor analysis. Results: During the study period we observed a decrease in the incidence of intracranial haemorrhage from 44% (1985/86) to 24% (1989/90) in infants ≤ 1000 g, from 26% to 21% between 1001 and 1250 g and from 18% to 7% in the weight group from 1251 to 1500 g. Using multiple logistic regression with adjustment for 4 predefined variables (gestational age, year of birth, sex, respiratory distress syndrome) we could identify the following risk factors predictive of intracranial haemorrhage: low gestational age, absence of a paediatrician at birth, Apgar values < 7, umbilical artery cord pH ≤ 7.25, duration of transport > 30 min. In addition, hypothermia ≤ 36°C, haemoglobin concentration ≤ 14 g/dl, base excess ≤ -6 mval/l, pH value ≤ 7.15 on admission to the neonatal intensive care unit and the occurrence of septicemia, respiratory distress syndrome, pulmonary interstitial emphysema or pneumothorax were associated with an increased risk for intracranial haemorrhage. Infants ≤ 1500 g born outside the perinatal centre or infants ≤ 1500 g born by vaginal delivery had a significantly increased risk to develop intracranial haemorrhage. Conclusions: Centralization of high risk pregnancies in perinatal centres and improved standards of perinatal care may further reduce the incidence of intracranial haemorrhage in preterm infants. Our data seem to favour the use of Caesarian section in very small premature newborn infants.