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Research article
Kathy Burgoine
Mbale Regional Referral Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7975-745X
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Globally, 15 million neonates are born prematurely every year, over half in low income countries (LICs). Premature and low birth weight neonates have a higher risk of intraventricular haemorrhage (IVH). There are minimal data regarding IVH in sub-Saharan Africa. This study aimed to examine the incidence, severity and timing of and modifiable risk factors for IVH amongst low-birth-weight neonates in Uganda.
Methods
This is a prospective cohort study of neonates with birthweights of ≤2000g admitted to a neonatal unit (NU) in a regional referral hospital in eastern Uganda. Maternal data were collected from interviews and medical records. Neonates had cranial ultrasound (cUS) scans on the day of recruitment and days 3, 7 and 28 after birth. Risk factors were tabulated and are presented alongside odds ratios (ORs) and adjusted odds ratios (aORs) for IVH incidence. Outcomes included incidence, timing and severity of IVH and 28-day survival.
Results
Overall, 120 neonates were recruited. IVH was reported in 34.2% of neonates; 19.2% had low grade (Papile grades 1-2) and 15% had high grade (Papile grades 3-4). Almost all IVH (90.2%) occurred by day 7, including 88.9% of high grade IVH. Of those with known outcomes, 70.4% (81/115) were alive on day 28 and survival was not associated with IVH. We found that vaginal delivery, gestational age (GA) <32 weeks and resuscitation in the NU increased the odds of IVH. Of the 6 neonates who received 2 doses of antenatal steroids, none had IVH.
Conclusion
In this resource limited NU in eastern Uganda, more than a third of neonates born weighing ≤2000g had an IVH and the majority of these occurred by day 7. We found that vaginal birth, earlier gestation and need for resuscitation after admission to the NU increased the risk of IVH. This study had a high rate of SGA neonates and the risk factors and relationship of these factors with IVH in this setting needs further investigation. The role of antenatal steroids in the prevention of IVH in LICs also needs urgent exploration.
Keywords
Intraventricular haemorrhage, preterm, low birth weight, neonate, low income country
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CURRENT STATUS: Published
View the published article at BMC Pediatrics.
Version 3
Posted 28 Dec, 2020
No community comments so far
Editorial decision: Accept
On 09 Dec, 2020
Editor assigned
On 07 Dec, 2020
Submission checks complete
On 07 Dec, 2020
Editor invited
On 07 Dec, 2020
No comments provided
Review #2 received
Received 22 Nov, 2020
Editorial decision: Minor revision
On 22 Nov, 2020
Review #1 received
Received 03 Nov, 2020
Reviewer #2 agreed
On 18 Oct, 2020
Reviewer #1 agreed
On 15 Oct, 2020
Reviewers invited
Invitations sent on 13 Oct, 2020
Editor assigned
On 12 Oct, 2020
Submission checks complete
On 11 Oct, 2020
Editor invited
On 11 Oct, 2020
No comments provided
Editorial decision: Major revision
On 04 Sep, 2020
Review #1 received
Received 03 Sep, 2020
Review #2 received
Received 26 Aug, 2020
Reviewer #2 agreed
On 13 Aug, 2020
Reviewer #1 agreed
On 12 Aug, 2020
Reviewers invited
Invitations sent on 06 Aug, 2020
Editor invited
On 09 Jul, 2020
Editor assigned
On 08 Jul, 2020
First submitted
On 07 Jul, 2020
Submission checks complete
On 07 Jul, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Pediatrics
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A new preprint design is coming!
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See the published version of this preprint at BMC Pediatrics.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Kathy Burgoine
Mbale Regional Referral Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7975-745X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Pediatrics.
Version 3
Posted 28 Dec, 2020
No community comments so far
Editorial decision: Accept
On 09 Dec, 2020
Editor assigned
On 07 Dec, 2020
Submission checks complete
On 07 Dec, 2020
Editor invited
On 07 Dec, 2020
No comments provided
Review #2 received
Received 22 Nov, 2020
Editorial decision: Minor revision
On 22 Nov, 2020
Review #1 received
Received 03 Nov, 2020
Reviewer #2 agreed
On 18 Oct, 2020
Reviewer #1 agreed
On 15 Oct, 2020
Reviewers invited
Invitations sent on 13 Oct, 2020
Editor assigned
On 12 Oct, 2020
Submission checks complete
On 11 Oct, 2020
Editor invited
On 11 Oct, 2020
No comments provided
Editorial decision: Major revision
On 04 Sep, 2020
Review #1 received
Received 03 Sep, 2020
Review #2 received
Received 26 Aug, 2020
Reviewer #2 agreed
On 13 Aug, 2020
Reviewer #1 agreed
On 12 Aug, 2020
Reviewers invited
Invitations sent on 06 Aug, 2020
Editor invited
On 09 Jul, 2020
Editor assigned
On 08 Jul, 2020
First submitted
On 07 Jul, 2020
Submission checks complete
On 07 Jul, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Pediatrics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Pediatrics.
Background
Globally, 15 million neonates are born prematurely every year, over half in low income countries (LICs). Premature and low birth weight neonates have a higher risk of intraventricular haemorrhage (IVH). There are minimal data regarding IVH in sub-Saharan Africa. This study aimed to examine the incidence, severity and timing of and modifiable risk factors for IVH amongst low-birth-weight neonates in Uganda.
Methods
This is a prospective cohort study of neonates with birthweights of ≤2000g admitted to a neonatal unit (NU) in a regional referral hospital in eastern Uganda. Maternal data were collected from interviews and medical records. Neonates had cranial ultrasound (cUS) scans on the day of recruitment and days 3, 7 and 28 after birth. Risk factors were tabulated and are presented alongside odds ratios (ORs) and adjusted odds ratios (aORs) for IVH incidence. Outcomes included incidence, timing and severity of IVH and 28-day survival.
Results
Overall, 120 neonates were recruited. IVH was reported in 34.2% of neonates; 19.2% had low grade (Papile grades 1-2) and 15% had high grade (Papile grades 3-4). Almost all IVH (90.2%) occurred by day 7, including 88.9% of high grade IVH. Of those with known outcomes, 70.4% (81/115) were alive on day 28 and survival was not associated with IVH. We found that vaginal delivery, gestational age (GA) <32 weeks and resuscitation in the NU increased the odds of IVH. Of the 6 neonates who received 2 doses of antenatal steroids, none had IVH.
Conclusion
In this resource limited NU in eastern Uganda, more than a third of neonates born weighing ≤2000g had an IVH and the majority of these occurred by day 7. We found that vaginal birth, earlier gestation and need for resuscitation after admission to the NU increased the risk of IVH. This study had a high rate of SGA neonates and the risk factors and relationship of these factors with IVH in this setting needs further investigation. The role of antenatal steroids in the prevention of IVH in LICs also needs urgent exploration.
Figure 1
Figure 2
This is a list of supplementary files associated with this preprint. Click to download.
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