Neonatal intraventricular hemorrhage (IVH), a fetal and neonatal alloimmune thrombocytopenia (FNAIT) complication, appears to occur most frequently six hours after birth (HOA) in preterm infants, according to a recently published study in JAMA Pediatrics.
“Most IVH occurs during the first three days of life; however, the exact onset is typically unknown in individual events,” the authors wrote.
The authors used a meta-analysis, a method that combines results from different studies on a given subject to produce a pooled estimate of the result, to determine the approximate time of onset of IVH in preterm neonates, and to assess whether therapeutic improvements reduced IVH’s incidence.
The meta-analysis included data from 64 studies and over 9000 patients. Researchers compared studies published before and after 2007, observing no significant difference in the reported incidence of IVH among preterm newborns.
The proportion of IVHs occurring before six HOA was significantly lower in studies published after 2007, with very early IVH accounting for 35% of cases before 2007 and 9% of cases after 2007. These findings represent a four-fold decrease in the incidence of very early IVH.
“Less than 10% of all IVH in preterm infants occurred before six hours of life,” the authors concluded. “ These data suggest that recently implemented preventive measures have the potential to postpone rather than reduce IVH in very preterm infants.”
Understanding IVH and FNAIT
IVH is an intracranial hemorrhage (ICH) subtype in which the bleeding occurs in brain structures known as the ventricles. Fetuses and neonates with thrombocytopenia have an increased risk of intracranial bleeding, and approximately 10% of newborns and fetuses with FNAIT suffer ICHs.
ICHs are associated with severe sequelae, including perinatal death and severe neurological disabilities, including cerebral palsy, severe cognitive impairment, bilateral deafness, and blindness. According to some studies, approximately 9% of children with FNAIT who suffer from ICH will have special education needs.
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