Peri-intraventricular hemorrhage in premature newborns: associated with immediate umbilical cord clamping, vaginal delivery and surfactant use

Sousa, Danielle Albuquerque; Ferreira, Pedro Lucas de Morais; Camargo, Juliana Dantas de Araújo Santos; Silveira, Sarah de Lima Alloufa da; Barreto, Anna Christina do Nascimento Granjeiro

doi:10.1590/1806-9304202500000119-en

person Danielle Albuquerque Sousa

conception · design of the study · data collection · filling in the spreadsheets · analysis · interpretation of the results · writing · critical revision of the content of the manuscript · approved the final version of the article · declare no conflicts of interest

schoolPrograma de Residência Médica em Neonatologia. Maternidade Escola Januário Cicco. Universidade Federal do Rio Grande do Norte/Empresa Brasileira de Serviços Hospitalares (MEJC/UFRN/EBSERH). Av. Nilo Peçanha, 259. Petrópolis. Natal, RN, Brazil. CEP: 59.012-310

0009-0008-6592-426X

person Pedro Lucas de Morais Ferreira

statistical analysis of the data · analysis · interpretation of the results · writing · critical revision of the content of the manuscript · approved the final version of the article · declare no conflicts of interest

schoolPrograma de Iniciação Científica do CNPq. Universidade Federal do Rio Grande do Norte. Natal, RN, Brasil

0009-0000-0967-9708

person Juliana Dantas de Araújo Santos Camargo

design of the research methodology · statistical analysis of the data · analysis · interpretation of the results · writing · critical revision of the content of the manuscript · approved the final version of the article · declare no conflicts of interest

schoolPrograma de Residência Médica em Neonatologia. Maternidade Escola Januário Cicco. Universidade Federal do Rio Grande do Norte/Empresa Brasileira de Serviços Hospitalares (MEJC/UFRN/EBSERH). Av. Nilo Peçanha, 259. Petrópolis. Natal, RN, Brazil. CEP: 59.012-310

0000-0001-8692-5706

person Sarah de Lima Alloufa da Silveira

research design · writing · critical revision of the content of the manuscript · approved the final version of the article · declare no conflicts of interest

schoolPrograma de Residência Médica em Neonatologia. Maternidade Escola Januário Cicco. Universidade Federal do Rio Grande do Norte/Empresa Brasileira de Serviços Hospitalares (MEJC/UFRN/EBSERH). Av. Nilo Peçanha, 259. Petrópolis. Natal, RN, Brazil. CEP: 59.012-310

0000-0002-5817-9774

person Anna Christina do Nascimento Granjeiro Barreto

conception · design of the study · data collection · filling in the spreadsheets · analysis · interpretation of the results · writing · critical revision of the content of the manuscript · approved the final version of the article · declare no conflicts of interest

schoolPrograma de Residência Médica em Neonatologia. Maternidade Escola Januário Cicco. Universidade Federal do Rio Grande do Norte/Empresa Brasileira de Serviços Hospitalares (MEJC/UFRN/EBSERH). Av. Nilo Peçanha, 259. Petrópolis. Natal, RN, Brazil. CEP: 59.012-310

0000-0001-7319-5011

Associated Editor:

Lygia Vanderlei

Grade	Description
I	Hemorrhage only in the germinal matrix or intraventricular hemorrhage in up to 10% of the ventricular area.
II	Hemorrhage in the germinal matrix and ventricular hemorrhage between 10-50% of the ventricular area
III	Hemorrhage in the germinal matrix and involving more than 50% of the ventricular area, with ventricular distension.
Hemorrhagic heart attack	Ipsilateral peri-intraventricular hemorrhagic heart attack in the white matter, and large intra-ventricular hemorrhage (referred to in this study as grade IV for ease of understanding).

Categorical variables	n %
Maternal age (years)	501 100.0
< 20	76 15.2
20-35	342 68.3
>35	83 16.6
Neonate's sex	503 100.0
Male	255 50.7
Female	248 49.3
Gestational age at birth	503 100.0
Up to 28 weeks and 6 days	189 37.6
>29 weeks	314 62.4
Birth weight (grams)	503 100.0
Up to 999	153 30.4
>1,000	350 69.6
Quantitative variables	X ± SD
Maternal age (years)	27.8 ± 7.2
Prenatal consultations (number)	4.7 ± 2.3
Gestational age at birth (weeks)	29.5 ± 2.5
Birth weight (grams)	1.251 ± 385
Follow-up time to final outcome (days)	56.05 ± 32.27

Variables	N	Group		pa
Variables	N	With PIVH	Without PIVH	pa
Maternal age (years)	501	27 ± 7	28 ± 7	0.410
Maternal age (years); n (%)	501			0.216
< 20	76	31 (40.8)	45 (59.2)
20 - 35	342	104 (30.4)	238 (69.6)
> 35	83	27 (32.5)	56 (67.5)
Prenatal consultations; (number)	409	4.4 ± 2.1	4.9 ± 2.4	0.,033
Gestational hypertension; n (%)	502			0.020
Yes	219	59 (26.9)	160 (73.1)
No	283	104 (36.7)	179 (63.3)
Gestational diabetes; n (%)	502			0.988
Yes	71	23 (32.4)	48 (67.6)
No	431	140 (32.5)	291 (67.5)
Antenatal corticoid; n (%)	493			0.050
Complete cycle	282	82 (29.1)	200 (70.9)
No or incomplete cycle	211	79 (37.4)	132 (62.6)
Magnesium sulphate; n (%)	491			0.043
Yes	187	50 (26.7)	137 (73.3)
No	304	108 (35.5)	196 (64.5)

Variables	N	Group		pa
Variables	N	With PIVH	Without PIVH	pa
Sex; n (%)	503			0.074
Male	255	92 (36.1)	163 (63.9)
Female	248	71 (28.6)	177 (71.4)
Gestational age at birth (weeks)	503	28.8 ± 2.8	29.9 ± 2.4	<0.01
Gestational age at birth; n (%)	503			0.004
Up to 28 weeks and 6 days	189	76 (40.2)	113 (59.8)
≥29 weeks	314	87 (27.7)	227 (72.3)
Birth weight (grams)	503	1.194 ± 408	1.279 ± 371	0.020
Birth weight (grams); n (%)	503			0.005
Up to 999	153	63 (41.2)	90 (58.8)
≥1.000	350	100 (28.6)	250 (71.4)
Small for gestational age; n (%)	503			0.284
Yes	110	31 (28.2)	79 (71.8)
No	393	132 (33.6)	261 (66.4)
Type of delivery; n (%)	503			0.008
Cesarean section	325	92 (28.3)	233 (71.7)
Vaginal	178	71 (39.9)	107 (60.1)
Time of ruptured sac (hours)	498	22.9 ± 75.6	26.7 ± 82.8	0.621
Type of pregnancy; n (%)	503			0.528
Multiple	88	26 (29.5)	62 (70.5)
Singleton	415	137 (33.0)	278 (67.0)
Umbilical cord clamping time 2; n (%)	459			0.002
Immediate (< 30 seconds)	324	123 (38.0)	201 (62.0)
≥30 seconds	135	31 (23.0)	104 (77.0)
Resuscitation in delivery room; n (%)	485			<0.01
Yes	280	108 (38.6)	172 (61.4)
No	205	47 (22.9)	158 (77.1)
Temperatura de admissão; n (%)	470			0.951
< 36.5	383	123 (32.1)	260 (67.9)
36.5 - 37.5	76	24 (31.6)	52 (68.4)
>37.5	11	4 (36.4)	7 (63.6)
Admission temperature; (degrees)	467	35.4 ± 1.3	35.6 ± 1.1	0.097
Apgar score at 1^st minute; n (%)	498			0.003
< 7 points	235	92 (39.1)	143 (60.9)
≥7 points	263	70 (26.6)	193 (73.4)
Apgar score at 5^th minute; n (%)	498			0.001
< 7 points	80	40 (50.0)	40 (50.0)
≥7 points	418	122 (29.2)	296 (70.8)
Use of mechanical ventilation; n (%)	503			<0.01
Yes	293	119 (40.6)	174 (59.4)
No	210	44 (21.0)	166 (79.0)
Respiratory distress syndrome (surfactant use); n (%)	503			<0.01
Yes	221	100 (45.2)	121 (54.8)
No	282	63 (22.3)	219 (77.7)
Pulmonary hemorrhage; n (%)	503			<0.01
Yes	85	41 (48.2)	44 (51.8)
No	418	122 (29.2)	296 (70.8)
Persistent ductus arteriosus; n (%)	497			<0.01
Yes	120	54 (45.0)	66 (55.0)
No	377	105 (27.9)	272 (72.1)
Use of vasoactive drugs; n (%)	501			<0.01
Yes	155	72 (46.5)	83 (53.5)
No	346	91 (26.3)	255 (73.7)
Use of CPAP in the delivery room; n (%)	502			<0.01
Yes	319	77 (24.1)	242 (75.9)
No	183	86 (47.0)	97 (53.0)

Parameter	B	Standard Error	χ2	p	RR	95%CI
(Intercept)	.117	.0330	12.705	<.001	1.125	1.054-1.200
Clamping time < 30 sec.	.085	.0356	5.693	.017	1.089	1.015-1.167
Clamping time ≥ 30 sec. (reference) Use of surfactant	.151	.0322	22.015	<.001	1.163	1.092-1.239
No use of surfactant (reference) Vaginal delivery Cesarean delivery (reference)	.104	.0327	10.139	.001	1.110	1.041-1.183

[TFN1] ^a
Significance of difference between groups by Student’s t-test (continuous variables) or Pearson’s chi-squared test (categorical variables); Continuous data are expressed as mean and standard deviation; categorical data are expressed as absolute (n) and relative (%) frequency.

Peri-intraventricular hemorrhage in premature newborns: associated with immediate umbilical cord clamping, vaginal delivery and surfactant use

Abstract