Neonatal-Perinatal Medicine Fellow Walter Reed National Military Medical Center Silver Spring, Maryland, United States
Background: Intraventricular hemorrhage (IVH) is a complication associated with preterm birth. As the field of neonatology improves, more infants born with lower birthweights and at lower gestational ages are surviving – but it is these infants who are most at risk for IVH. IVH is a significant predictor of individual morbidity and mortality. Two single center studies report specifically on characteristics of intubation (number of attempts, location, premedication, etc.) and incidence/severity of IVH; however, these papers have conflicting results. Objective: As the largest and only multi-center study focusing on this topic, the goal of this study is to identify what modifiable factors of care place these infants at highest risk for IVH. Design/Methods: This is a multi-center retrospective cohort study from 2011-2021 across the Military Health System. Preterm infants born during the study years who qualified for a screening head ultrasound are included. Infants are excluded if they were outborn or never received a head ultrasound. The primary aim of the study is to evaluate the association between number of intubation attempts and IVH outcome. Secondary aims are to evaluate the associations between premedication use/location of intubation (delivery room vs NICU) and IVH outcome. A Chi-square test for trend and multivariable logistic regression models evaluated associations of number of intubation attempts and infant/treatment characteristics with IVH severity. Results: 663 infants’ records were evaluated for inclusion and 564 infants were found to be eligible. 26.2% had any IVH (18.6% having mild and 7.6% having severe IVH), consistent with national average. The frequency of ≥1 intubation attempt was 60.1% in patients with IVH Grade 0, 69.5% Grade 1 or 2, and 95.3% Grade 3 or 4 (p for trend < 0.001). In a multivariable logistic regression model of severe IVH, the number of intubation attempts was associated with increased risk of severe IVH (OR = 1.25 (95% CI 1.03-1.50)), adjusted for infant characteristics. Among infants who had ≥1 intubation attempt, the number of attempts remained associated with increased risk of severe IVH (OR = 1.26 (95% CI 1.01-1.55)) and was, again, found to be independent of infant characteristics, use of premedication, and location of intubation.
Conclusion(s): While data collection is still ongoing, these findings suggest an association between increasing number of intubation attempts and higher risk of severe IVH. The outcomes from this study add to the growing body of literature addressing modifiable practices to decrease the incidence of IVH and improve outcomes for premature infants.
