Prenatal events and the risk of subependymal/intraventricular haemorrhage in very low birthweight neonates.

The effects of prenatal factors on the risk of subependymal and/or intraventricular brain haemorrhage in very low birthweight (VLBW) neonates were studied. Data were collected on 201 consecutively born VLBW neonates without major congenital anomalies, who were born at a regional obstetric referral centre. Brain haemorrhage was identified by cranial ultrasound examinations. The reliability of these examinations (concordance among readers' interpretations) was assessed and found to be moderate (kappa = 0.47 for the finding of subependymal haemorrhage (SEH); kappa = 0.50 for the finding of intraventricular haemorrhage (IVH)). Prenatal factors were more strongly associated with IVH than with SEH. In univariable analyses, maternal pre-eclampsia, multiple gestation and maternal treatment with betamethasone were associated most strongly with a decreased risk of haemorrhage whereas labour and vaginal delivery were associated most strongly with an increased risk. These associations remained in a multivariable analysis which included prenatal events (maternal illnesses, fetal presentation and obstetrical interventions), as well as gestational age, birthweight, gender, treatment with assisted ventilation, and the occurrence of pneumothorax. Further aetiological study of the effects of prenatal factors could provide information useful in preventing SEH/IVH.