A Survey On The Incidence Of Intraventricular Hemorrhage Based On Magnetic Resonance Imaging And Its Risk Factors In The Preterm Infants With Gestational Age Less Than 32 Weeks

Objective:With the improvement of treatment technology,more and more very low birth weight and extremely low birth weight infants(medium-early,very early,and extremely early preterm infants)survive,but the incidence of intraventricular hemorrhage(IVH)increases with the gestational age.Previous studies on the occurrence and risk factors of IVH in preterm infants are mostly based on ultrasound diagnosis,but there are few studies based on head magnetic resonance imaging with a large sample size.This study aims to investigate the risk factors and epidemiological characteristics of IVH in moderate and early preterm infants based on MRI diagnosis.Methods: A retrospective analysis was performed on the clinical data of preterm infants with gestational age < 32 weeks who were admitted to the Department of Neonatology,Shengjing Hospital of China Medical University from January 2018 to August 2022,except those who did not undergo conventional magnetic resonance imaging(Tl WI-T2WI)and diffusion weighted imaging(DWI).IVH was classified into four grades according to Papile criteria.The prenatal and intrapartum risk factors,clinical manifestations and laboratory examination results after birth were collected to describe the occurrence of IVH,and the related risk factors of IVH in medium and early preterm infants were analyzed.Results:Among 1418 preterm infants with gestational age < 32 weeks,166(11.7%)had IVH,136(9.6%)had mild IVH and 30(2.1%)had severe IVH.The incidence of IVH was highest in the youngest GA subgroup(GA < 28 weeks,28/118,23.7%).With the increase of GA,the incidence of IVH decreased to 13.1%(61/465)at 28-30 weeks and 9.2%(77/835)at 30-32 weeks(P < 0.001).Multivariate analysis showed that prenatal hormone(OR=0.634,95%CI 0.433-0.928,P=0.019),cesarean section(OR=0.255,95%CI 0.172-0.378,P=0.019),gestational hypertension(OR=0.571,95%CI 0.334-0.974,P=0.040),and high Apgar score at 1 minute after birth(OR=0.833,95%CI 0.702-0.988,P=0.040)were the independent protective factors for IVH,and PDA(OR=1.658,95%CI 1.059-2.595,P=0.027)was the independent risk factor for IVH in preterm infants.Gestational age(OR=0.732,95%CI 0.583-0.921,P=0.008)and prenatal steroids(OR=0.229,95%CI 0.063-0.841,P=0.026)wereindependent protective factors for severe IVH in preterm infants.However,late complications such as LOS and NEC in preterm infants do not increase the incidence of IVH.Conclusion:The incidence of IVH in preterm infants is related to gestational age,and the lower the gestational age,the higher the incidence of IVH.PDA increases the incidence of IVH,and prenatal hormone,cesarean section,gestational hypertension,and high Apgar score at 1 minute after birth have protective effects.