Magnitude and Pattern of Germinal Matrix Hemorrhage in newborns born below 32 weeks of gestational age at Saint Paul’s Hospital Millennium Medical College, Addis Ababa, 2018

Abstract

Abstract Background: Intraventricular / Germinal matrix hemorrhage (IVH/GMH) remains a significant cause of morbidity and mortality in infants who are born prematurely. Sequelae of GM/IVH include short and long term complications that results in life-long neurologic deficits, most importantly cerebral palsy, developmental delay and seizures. GM/IVH is diagnosed primarily through the use of brain imaging studies, specifically cranial ultrasonography. Because GM/IVH can occur without clinical signs, screening and serial examinations are necessary for the diagnosis. Objective: To determine magnitude, pattern and predictors of intraventricular hemorrhage in newborns born below 32 weeks of gestational age and admitted at Saint Paul’s Hospital Millennium Medical College (SPHMMC) neonaltal intensive care unit (NICU). Methods: A prospective cross–sectional hospital based study was conducted where 97 preterm neonates meeting the study's inclusion criteria had cranial ultrasound done after the first 48 hours of age. Data on the risk factors was obtained from the neonatal referral form, maternal records and direct interview with the neonate's mother Result: In this study, of the total 97 neonates, 63 neonates (64.9%) had normal brain sonography, while 34 neonates (35.1%) had IVH/GMH. Grade 1 IVH was the most common(47.1%) followed by grade 2 IVH at 29.4%. This made mild IVH (grade 1 and grade 2) 76.5% of the total IVH cases detected. Grade 3 IVH was the third common at 20.6% and grade 4 IVH was the least making 2.9%. There was significant reduction in magnitude of IVH in those neonates whose mothers were given antenatal steroid (p=0.003, RR=0.45, 95%CI 0.26-0.76). Conclusion and Recommendation: The magnitude of IVH in very preterm/VLBW neonates is high, therefore all very preterm/VLBW neonates should be serially scanned. Antenatal steroid administration significantly decreases magnitude of IVH. Hence, antenatal steroid should be administered to pregnant women at risk for preterm delivery. Keywords: Transfontanelle ultrasound, Intraventricular hemorrhage, Preterm neonate.