الفهرس 
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Abstract
During the last decades, the survival of preterm infants has increased dramatically. This increased survival is mainly due to the increased quality of the neonatal intensive care. Nevertheless, the incidence of neurological problems remains high. The most important neurological manifestations of brain damage in preterm infants are cognitive and motor handicaps. Intraventricular hemorrhage can be the cause of the development of cerebral palsy and mental retardation. The risk factors for IVH include both perinatal and postnatal events.
Intraventricular hemorrhage originates in the subependymal germinal matrix layer of the developing brain with possible rupture into the ventricular system. This layer gradually decreases in size as the fetus matures and is virtually absent in full term babies.
The aim of the work is to study the risk factors for intraventricular hemorrhage in low birth weight preterm infants (less than 32 weeks gestation).
The current study was conducted on one hundred preterm infants admitted at the Neonatal Intensive Care Unit, Alexandria University Children’s Hospital between May 2006 and May 2007, with gestational age from 26-32 weeks (mean=30.39±SD), 45 were males and 55 were female. All of them were born in Alexandria University Maternity Hospital at and their deliveries were attended by a neonatologist.
All newborn infants included in the study were subjected to:
1. Thorough history taking including
a. Maternal pregnancy history [age, smoking, pregnancy induced hypertension, pre-eclampsia, assisted reproductive techniques, cervical incompetence and circlage, placenta previa, abruptio placenta, chorioamnionitis, prolonged rupture of membranes, multiple pregnancy, antenatal administration of steroid (dexamethasone 12mg I.M daily for 2 days), tocolytic therapy using sympathomimetic].
b. Perinatal history [presentation , mode of delivery , duration of labor, vigorous resuscitation, Apgar score at 1 & 5 minutes].
2. Full clinical examination
For assessment of gestational age, evidence of neonatal sepsis, respiratory distress syndrome, patent ductus arteriosus.
From neonatal charts we recorded the following data: need for bag and mask, CPAP, IPPV, ventillatory asynchrony, administration of surfactant, bicarbonate infusion (as replacement therapy in cases of metabolic acidosis or during resuscitation), prophylactic indomethacin, inotropes, convulsions, apnea, pneumothorax, anemia, hypoglycemia, bleeding tendency.
3. Laboratory investigations obtained from the neonatal files:
a. Complete blood count.
b. Complete sepsis work up (blood culture, urine analysis, urine culture, CSF analysis,
CSF culture and C reactive protein) in suspected cases of septicemia.
c. Chest x-ray and arterial blood gases in preterm infants with respiratory distress
syndrome.
d. Echocardiography if patent ductus arteriosus is suspected.
4. Cranial ultrasound:
The diagnosis of IVH was based on cranial U/S examination. Ultrasonographic examination of the brain was done according to the following schedule:
1- In the first 72 hours to all infants.
2-Follow up ultrasonography was done for cases with IVH one week after the initial
sonogram for early detection of hydrocephalus.
3-In cases without IVH, cranial ultrasound was repeated before discharge.
The results of the study could be summarized as follows:
1-The study included 38% of infants delivered at 32 weeks and 62% were<32weeks
2- Twenty five percent of the neonates were small for their gestational age while 75% were appropriate regarding weight, length and head circumference. In 30% a murmur was present on cardiac examination, 31% had HMD and 46% had neonatal pneumonia.
3- No cases were reported to have maternal smoking, intrauterine infection or cervical incompetence. Sixty seven percent received complete course of antenatal steroid, 40% received tocolytic therapy, 26% had maternal pre-eclampsia and 24% had abruptio placenta.
4- After admission to NICU, 37% needed oxygen therapy by bag and mask, 43% needed mechanical ventilation, and 57% were managed by CPAP. Twenty two percent received bicarbonate infusion, 18% showed bleeding tendency and 7% had hypoglycemia. Transfusions either of plasma, platelet, or packed RBCs were reported in 81%. Inotropes in the form of dopamine ± dobutamine were given to 77% of infants, and prophylactic indomethacin was given to 69 %.
5- In the first cranial ultrasound ( done in the first 72 hours of life ),76% of studied infants showed no evidence of IVH , and IVH was proved in 24% ( 3% had grade I IVH, 8% had grade II IVH, 11% had grade III IVH, and 2% had grade IV).
6- After the second ultrasonography. The total number of cases with IVH increased from 24% to 30%.
7- Thirteen neonates who had IVH (43.3% of affected infants) were asymptomatic, while 12 neonates (40%) had saltatory picture, and the remaining 5 (16.7%) had the catastrophic clinical picture.
8- The mortality rate was 30% in infants with IVH compared to 16% in cases without IVH. Five cases developed post hemorrhagic ventricular dilatation.
9- Comparison between infants with IVH and infants without IVH showed statistically significant differences in gestational age (significantly lower in infants with IVH), history of PROM ( more in IVH), and history of antenatal administration of corticosteroids ( less frequently used in IVH ). On the other hand, studied variables as pregnancy hypertension, ART, placenta previa, abruptio placenta, pre-eclampsia, chorioamnionitis, tocolytic agents or maternal age did not show any statistically significant difference between both groups.
10- Comparison between both groups regarding perinatal data showed that non-cephalic presentation, delivery room intubation, prolonged duration of labor, low Apgar score at 1 minute and 5 minutes were significantly associated with development of IVH but no statistically significant difference regarding mode of delivery.
11- The body weight and lowest mean blood pressure were significantly lower in the group with IVH, while highest mean blood pressure was significantly higher in infants with IVH. There was no statistically significant difference between both groups regarding heart rate, respiratory rate, oxygen saturation, and gender.
12- There was a statistically significant difference between both groups regarding use of bag and mask, IPPV, CPAP, ventillatory asynchrony, pneumothorax, HMD, convulsions, apnea, anemia, sepsis, bleeding tendency, bicarbonate infusion, transfusions, inotropes, prophylactic indomethacin, and surfactant therapy. They were all more frequent in the group of infants with IVH.
13- The lowest hemoglobin and lowest platelet count were significantly lower in infants with IVH, while WBCs count and CRP were significantly higher in infants with IVH. There was no statistically significant difference between both studied groups in first hematocrit value.
14- PDA was significantly more frequent among infants with IVH.