Periventricular leucomalacia-intravetricular haemorrhage and associated perinatal factors among very low birth weight infants at Muhimbili National Hospital (MNH)

Introduction and review of literature Periventricular leucomalacia and intraventricular haemorrhage are two most important antecedents of neurodevelopmental outcome in very low birth weight infants Study objective To determine the incidence of PVL/IVH and it's associated perinatal factors among very low birth weight (VLBW) infants admitted at neonatal unit Muhimbili National Hospital. Material and methods Prospective study with a nested case-control study was conducted at the neonatal unit from May to November 2000. A total of 4539 neonates were admitted to the neonatal unit during the study period and among these 443 (9.8%) were VLBW. Three hundred seventy two VLBW neonates were recruited to the study on admission to the neonatal unit. The neonates were followed up to the postnatal age of 4 weeks or death depending on which came first. All 372 neonates had initial cranialultrasound examination within 72 hours of life. Cranial-ultrasound was done on 179 and 151 neonates at the postnatal age of 2 weeks and 4 weeks respectively. At the end of the follow up study some neonates had developed PVL and or IVH. Records of all 372 neonates were reviewed to determine the presence or absence of the various perinatal factors.These data was analysed as case-control study with case and control as shown below: Case: Any VLBW who had been recruited in the follow up study and had Diagnosis of either PVL or IVH or both by cranial ultrasound. Control: Any VLBW who had been recruited in the follow up study without a Diagnosis of either PVL or IVH by cranial ultrasound Results The incidence of VLBW was 9.8% and two hundred fifty seven (58%) out the 443 VLBW neonates died before the postnatal age of 4 weeks. The overall incidence of PVL was 121 / 372 (32 .5%) and that of IVH was 230/372 (61.8%). Most of the PVL and IVH occurred during the first 3 days of life. All neonates with grade IV IVH died before the postnatal age of 4 weeks. Forty-seven neonates (12.6%) developed osthaemorrhagic hydrocephalus. Maternal haemoglobin and neonatal haemoglobin showed significant 'association with PVL and IVH respectively. Conclusion and Recommendations There is high incidence of VLBW, IVH and PVL. IVH grade IV carries high mortality. Routine cranial-ultrasound on all VLBW neonates along with clinical follow up for long-term neurodevelopmental outcome is recommended. Residents in paediatrics should be taught how to perform cranial-ultrasound examination during their postgraduate training.