Table 1.
Neonatal Demographics, Pregnancy Characteristics, and Perinatal Factors for Severe Intraventricular Hemorrhage of Hemodynamic Screening versus Historical Control Subjects
| Hemodynamic Screening (n = 191) | Historical Control Subjects (n = 423) | P Value | |
|---|---|---|---|
| Gestational age, wk | 24.6 ± 1.5 | 24.8 ± 2.1 | 0.1 |
| Number of 22–23-wk neonates | 78 (41) | 137 (32) | 0.04 |
| Birth weight, g | 686 ± 185 | 704 ± 193 | 0.32 |
| Female | 85 (45) | 222 (53) | 0.07 |
| Inborn | 165 (86) | 343 (82) | 0.11 |
| 5-min Apgar score | 7 [6, 7] | 7 [6, 8] | 0.78 |
| Intubation in delivery room | 178 (93) | 376 (89) | 0.1 |
| CPR in the delivery room | 4 (2) | 30 (7) | 0.02 |
| Maternal factors | |||
| Antepartum steroids | |||
| None | 14 (7) | 58/421 (14) | 0.03 |
| Partial | 41 (22) | 102/421 (24) | |
| Complete | 136 (71) | 261/421 (62) | |
| Maternal magnesium sulfate | 156/179 (87) | 165/336 (49) | <0.001 |
| Delayed cord clamping | 101/177 (57) | 61/353 (17) | <0.001 |
| Maternal antibiotics | |||
| None | 30/179 (17) | 116/335 (35) | <0.001 |
| Partial | 46/179 (26) | 70/355 (21) | |
| Complete | 103/179 (58) | 149/355 (45) | |
| Pregnancy/delivery factors | |||
| Maternal age, yr | 28.9 ± 6 | 27.4 ± 6 | 0.004 |
| Multiple birth | 57 (30) | 109 (26) | 0.91 |
| Fertility treatment | 11/173 (5) | 34/420 (8) | 0.47 |
| Antepartum NSAID exposure | 13/171 (8) | 4/416 (1) | <0.001 |
| Obesity | 70/177 (40) | 54/416 (13) | <0.001 |
| Gestational diabetes | 11/184 (6) | 25/420 (6) | 0.99 |
| Hypertension of pregnancy | 20/188 (11) | 47/421 (11) | 0.51 |
| Chorioamnionitis | 21/186 (11) | 57/422 (14) | 0.45 |
| Prolonged rupture of membranes | 70 (37) | 122/418 (29) | 0.07 |
| Maternal smoking | 32/188 (17) | 92/418 (22) | 0.16 |
| Maternal SSRI use | 19/179 (11) | 12/415 (3) | <0.001 |
| Maternal drug use | |||
| None | 145/190 (85) | 377/418 (90) | <0.001 |
| Cannabis | 31/190 (16) | 25/418 (6) | |
| Methamphetamine | 1/190 (1) | 3/418 (1) | |
| Opiates | 2/190 (1) | 4/418 (1) | |
| Alcohol | 7/190 (4) | 3/418 (1) | |
| Multiple | 4/190 (2) | 6/418 (1) | |
| Induction of labor | 7/182 (4) | 12/355 (3) | 0.78 |
| Delivery mode | |||
| Vaginal | 104 (47) | 189/421 (44) | 0.17 |
| Primary cesarean section | 87 (49) | 202/421 (48) | |
| Mixed (multiple birth) | 0 (4) | 30/421 (7) | |
| Breech vaginal delivery | 28 (15) | 33/304 (11) | 0.21 |
| Neonatal IVH risk factors 0–24 h | |||
| Platelets <100 | 7/185 (4) | 21/385 (6) | 0.39 |
| Morphine infusion | 21 (11) | 32/395 (8) | 0.25 |
| Change in CO2 in the first 24 h (mm Hg) | 62.5 ± 16 | 60.5 ± 16 | 0.18 |
| Lowest CO2 in the first 24 h, mm Hg | 35.7 ± 6 | 36.6 ± 11 | 0.43 |
| Mean hemoglobin, g/dl | 14.1 ± 1.8 | 13.8 ± 2 | 0.09 |
| Lowest hemoglobin, g/dl | 12.6 ± 2.2 | 12.4 ± 2.4 | 0.26 |
| Echocardiography evaluation | 191 (100) | 378/420 (90) | <0.001 |
| Postnatal day at first echocardiography | 0 [0, 0] | 6 [5, 7] | <0.001 |
| Peak illness severity 0–24 h | |||
| Mean respiratory severity score, mmol/L | 2.0 [1.7, 2.5] | 2.1 [1.6, 2.8] | 0.36 |
| Mean oxygenation index*, mmol/L | 3.9 [3, 5.2] | 4.1 [2.9, 5.9] | 0.22 |
| Sodium bicarbonate bolus | 8 (4) | 119 (29) | <0.001 |
| SNAPPE-II score, mmol/L | 21 [14, 30] | 24 [14, 36] | <0.001 |
| Highest lactate*, mmol/L | 4.5 [3, 6.9] | 5.1 [2.9, 8.8] | 0.12 |
| Approach to cardiovascular support | |||
| Inhaled nitric oxide in the first week | 9/182 (5) | 65/416 (16) | <0.001 |
| Hypotension in the first week† | 139 (73) | 346 (82) | 0.013 |
| Fluid alone | 31 (24) | 195/345 (55) | <0.001 |
| Vasopressor approach‡ | 3 (2) | 104 (30) | |
| Inotrope approach§ | 61 (47) | 13 (4) | |
| Hydrocortisone alone | 21 (16) | 27 (8) | |
| ⩾2 vasoactive infusions | 15 (12) | 6 (2) | |
| Maximum vasopressor-inotrope score | 5 [5, 12.5] | 10 [6, 14] | 0.005 |
| Hydrocortisone exposure first week | 99/190 (52) | 288 (70) | <0.001 |
Definition of abbreviations: CPR = cardiopulmonary resuscitation; IVH = intraventricular hemorrhage; NSAID = nonsteroidal anti-inflammatory drug; SNAPPE-II = score for neonatal acute physiology with perinatal extension-II; SSRI = selective serotonin reuptake inhibitor.
Data are expressed as mean ± SD, median [interquartile range], or frequency (percent).
Oxygenation index; arterial lactate available in n = 158 of 191 hemodynamic screening and n = 363 of 423 historical control subjects.
Mean arterial pressure < gestational age ⩾3 h consecutively.
Vasopressor approach is dopamine, norepinephrine, or vasopressin use.
Inotrope approach is dobutamine or epinephrine use.