Hemorragia peri-intraventricular em recém-nascidos pré-termos com restrição de crescimento intrauterino

Abstract

Background: Premature birth is associated with increased morbidity and mortality in the neonatal period. Intrauterine growth restriction is an important cause of interruption of gestation resulting in the occurrence of premature birth in addition to interfere in morbidity and mortality during neonatal period. The intraventricular hemorrhage is the most commonly brain injury found in the preterm newborn. The relationship between intrauterine growth restriction and periventricular hemorrhage is controversial in the literature. The present study aims to compare the incidence of intraventricular hemorrhage among preterm newborn with and without intrauterine growth restriction in addition to identify the risk factors for periventricular hemorrhage in these infants. Methods: This is a prospective cohort study and included premature infants that were born at the Clinics Hospital of Federal University of Uberlandia in a 12 months period. Newborns with congenital malformations, genetic syndromes, chromosome disorders, twins and those who died before 48 hours of life were excluded. Newborns were divided into 2 groups, with and without intrauterine growth restriction, based on the relationship between birth weight and gestational age. The ones classified as small for gestational age were considered with intrauterine growth restriction. Cranial ultrasounds were performed of all newborns and Papile (1978) classification was used for the diagnosis and classification of intraventricular hemorrhage. Results: 242 preterm newborns participated in this study being 120 in the group without and 122 in the group with intrauterine growth restriction. When compared maternal and newborn characteristics of the two groups, there were statistically significant difference in the incidence of maternal pre-eclampsia and birth weight. The periventricular hemorrhage was found in 19 (15,8%) preterm newborn without intrauterine growth restriction and in 28 (22,9%) with intrauterine growth restriction without statistically significant difference. In 38 (80.8%) infants the diagnosis of periventricular hemorrhage was made up to 7 days of life and were more common grades I and II. After adjustment for multiple logistic regression model, were defined as risk factors for the occurrence of periventricular hemorrhage thrombocytopenia and Respiratory Distress Syndrome. Conclusion: There was no statistically significant difference in the incidence of intraventricular hemorrhage among preterm newborn with and without intrauterine growth restriction. Logistic regression analysis indicated the Respiratory Distress Syndrome and thrombocytopenia as risk factors for the occurrence of intraventricular hemorrhage.