Abstract:
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 PVLjIVH 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 ~LBW. 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 cranial-
ultrasound examination within 72 hours of life. Cranial-ultrasound was
done on 1 79 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
VI
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 was121/372 (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 posthaemorrhagic
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-ultrasoul}d on all VLBW neonates along
with clinical follow up for long-term neurodevelopmental outcome is
recommended. Residents in paediatrics should be thought how to
perform cranial-ultrasound examination during their postgraduate
training.
