Prospektive Surveillance von Risikofaktoren für Hirnblutungen bei Frühgeborenen : Auswirkungen auf die Rate an Hirnblutungen und neurologische Untersuchung im korrigierten Alter von 2 Jahren
InstitutionsUKU. Klinik für Kinder- und Jugendmedizin
UKU. Klinik für Frauenheilkunde und Geburtshilfe
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Background: Intracranial hemorrhage (ICH) occurs in around 15-25% of premature infants with a gestational age <30 weeks and birth weight <1500g and an existing ICH increases the risk of neurodevelopmental impairements. Method: A working group at the University of Ulm, Germany, developed a prospective monitoring program for risk factors and a bundle of measures including altered clinical approaches to delivery, initial care of the neonate in the delivery room immediately after birth, and intensive care in the first few days for preterm infants with gestational age (GA) <30 weeks and birth weight <1500g. Adherence to these measures was checked regulary. The evaluation was performed for a period of 5 years (August 2010 to July 2015) compared to a historical control group (January 2008 to July 2010). Furthermore the neurodevelopmental outcome at the age of 24 months was assessed for the children treated with the bundle of measures (August 2010 to July 2013) compared to a historical control group (January 2008 to July 2010) by Bayley- II- Test and documentation of cerebral palsy, blindness and deafness. Impairement was defined by having either a Bayley -Score (PDI or MDI) <70, deafness, blindness or GMFCS≥1. Results: Before implementing the bundle of measurements 197 preterm infants with a median GA of 26,6 weeks (IQR 24,4-28,7 SSW) were born and after implementation 387 preterm infants with a median GA of 26,4 weeks (IQR 24,3-28,7). ICH rate was reduced from 52/197 (26,4%) significantly to 56/387 (14,5%) (p<0,001) for all grades of ICH. For ICH °III+°IV after Papile a reduction from 20/197 (10,2%) before to 24/387 (6,2%) after implementation (p=0,087) was seen. Before implementation 128/197 (65,0%) preterm infants were examined at corrected age of 24 months (Median GA 26,6 weeks; IQR (24,4-28,7), after implementation 173/226 (76,5%) (Median GA 27,4 weeks, IQR (25,3-28,7)). Overall ICH was significanty lower in the group after implementation [21/173 (12,1%) after versus 36/128 (28,1%) before, p<0,001]. ICH °III+°IV after Papile were lower after implementation of the bundle of measurements [12/128 (9,4%) before versus 7/173 (4,0%) after, p=0,06]. At the corrected age of 24 months in the group after implementation the rate of impaired children was significantly lower than in the group before [41/128 (32,0%) before versus 36/173 (20,8%), p=0,027 after]. Conclusions: The rate of ICH in premature neonates can be considerably lowered by prospective monitoring of risk factors. The reduced rate of ICH may improve the neurodevelopmental outcome at the age of 24 months.
Subject HeadingsHirnblutung [GND]
Cerebral hemorrhage [MeSH]
Infant, Premature [MeSH]