Abstract. Intraventricular hemorrhage (IVH) in neonates is an acquired lesion with .... seizures ,also there is high significant change in neonatal reflexes(Table 8).
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INCIDENCE OF INTRAVENTRICULAR HEMORRHAGE IN PRETERM NEONATES IN NICU at BAB –ELSHAR´YIA UNIVERSITY HOSPITAL By Atef El-Sayed Donia*,Hassan Aly Hassan*, Abd Elnaby Bayomi Mohamed**, Mohamed Mohamed fahmy amin***,Mohamed Amin Gebreel* ,Ibrahim Mohamed Abd Elghany* *Departments of pediatrics,**Radiology and ***community &Occupational medicine,Al-Azhar Faculty of Medicine Abstract Intraventricular hemorrhage (IVH) in neonates is an acquired lesion with enormous potential impact on morbidity, mortality and long-term neurodevelopmental outcome. Despite considerably improved neonatal care and increased survival of preterm infants over recent decades, IVH continues to be a significantly worrisome problem. Aim of this study: was to detect the incidence of intraventricular hemorrhage in preterm neonate in the neonatal intensive care unit at Bab-Elshaeria university hospital by screening all preterm neonates using cranial ultrasonography and to assess the different obstetric and neonatal risk factors associated with the development of intraventricular hemorrhage. This follow up study was conducted on 58 neonates who were admitted to neonatal intensive care unit (NICU) of Bab-Elsharia university Hospital, throughout the period from October 2011 to March 2012. An inclusion criterion was all preterm neonates less than 35 weeks gestational age. Detailed history taking: maternal, obstetric and delivery circumstances laying stress on maternal and obstetric risk factors of IVH. Assessment of the general condition using Apgar score at 1and 5 minutes, assessment of gestational age (GA) using Ballard score and recording of birth weight. Thorough clinical examination laying stress on vital signs especially blood pressure, complexion especially pallor and daily neurological examination. Imaging studies using cranial ultrasonography (CUS) at 2nd & 7th days of life. Laboratory investigations: hemoglobin, platelets, ABG & coagulation profile. Sixteen neonates Out of fift eight developed IVH (27.6%). Ten males (62.5% ) & 6 females (37.5% ) The majority of cases were grade I IVH representing 43.7 % (7cases) & grade III representing five patients (31.3% )while grade II was two patients and also grade IV two patients. IVH was inversely related to gestational age and birth weight as majority of cases were 1
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≤ 30 weeks 75% (12 preterm) and < 1500 g 68.7% (11 patients). It was found that the neurological signs were detected in 31.3% of cases of IVH were discovered in the 2 nd day of life,37.4% discovered on 7th day of life. The mortality rate of total neonates was 26.2% and 81.3% among cases with IVH,in which the higher mortality rate was found in high grases IVH.. Conclusion: The prevalence of asymptomatic cases with IVH was higher than symptomatic one. There are certain maternal and neonatal risk factors that are associated with increased risk of IVH. Cranial ultrasound can be considered as a specific and sensitive indicator for occurrence of IVH.
INTRODUCTION It has been estimated that intraventricular hemorrhage is the second commonest cause of neonatal deaths after congenital anomalies and is the primary postpartum finding in 20% babies dying in neonatal period. The figure rises to 50% to 70% if one considers only premature babies. (Debillon et al., 2003) The incidence of intraventricular hemorrhage is directly related to the maturity of infant and for infants weighing below 1500gm, it is about 50%. With reducing gestational age this incidence increases. With advancing gestational age intraventricular hemorrhage becomes progressively less common. The introduction of ultrasound has allowed frequent scanning of premature infants with Intraventricular hemorrhage. Clinical presentation of Intraventricular hemorrhage is often asymptomatic. (Rasul et al., 2004). Diagnosis of intraventricular hemorrhage is made on basis of clinical assessment and ultrasonographic evaluation. The development of high resolution real-time ultrasound scanner has provided a diagnostic modality with great potential to improve the ease of diagnosis and to increase the understanding of Intraventricular hemorrhage. Other imaging modalities which can be used to diagnose intraventricular hemorrhage are Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI). (Inder et al., 2003) The aim of the present study was to detect the incidence of intraventricular hemorrhage in the neonatal intensive care unit at Bab Elsharia university hospital by screening all preterm neonates using cranial ultrasonography and to assess the different
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obstetric and neonatal risk factors associated with the development of intraventricular hemorrhage. PATIENTS AND METHODS This follow up study was conducted on 58 preterm neonates (below 35 weeks)who were admitted to neonatal intensive care unit (NICU) of Bab Elsharia University Hospital through the period from October 2011 to March 2012.Ttheir birth weight ranged from 900 grams to 2.7 kg with a mean of 1.7 ±0.44 kg. All preterm babies were subjected to the following: Antenatal history: including maternal age, gestational age, maternal illness (hypertension, diabetes, anemia ,infection or cardiac disease etc). Natal history:Mode of labour, place of delivery and multiple births. Postnatal history: including Apgar score; resuscitation data, gestational age and anthropometric measurements. Systemic examination with stress on daily neurological examination: (level of consciousness, irritability, head circumference, anterior fontanel, tone, neonatal reflexes ,convulsions,apnea and abnormal movements). Ultrasonographic examination: Cranial ultrasonography (CUS) was done for all cases through the anterior fontanelle in both the coronal and sagittal planes using ShenzhenLandwind Ultrasound machine-China. Cranial ultrasonography was done twice, at day 2 and day 7 after delivery routinely and daily if IVH is suspected. Laboratory investigations: 1-Complete blood count . 2-Prothrombin time, activated partial thromboplastin time and international normalization ratio. The patients were divided into: Group I:Cases who had no evidence of IVH by CUS from birth to the end of 7 th day postnatal,42 cases (72.4%)
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Group II: Cases who had developed IVH by CUS from birth to the end of 7 th day postnatal ,16 cases (27.6%) Statistics were done by computer using Epi-info. Software, version
6.04. A word
processing, data base and statistics program. X mean, SD (standard deviation): to measure the central tendency of data and the distribution of data around their mean. IVH was highly significant in patients with lower gestational age as 75% of patients were ≤ 30 weeks (Table 1)
Table (1): gestational age of studied neonates in relation to IVH
Variables
Group I (No=42)
GA ( weeks ) 32.57 GA
GroupII (No=16) ±1.73 30.06
≤ 30 >30
6 (14.3%) 36 (85.7%)
±1.61
T
P
Sig
5.03
0.0001
HS
0.0001
HS
12 (75%) X2=19.9 4 (25%)
There was a highly significant inverse relation between IVH&decresed birth weight (table 2) Table (2): Relation between birth weight and IVH in studied neonates
Weight
4
Total cases
GroupI (No=42)
GroupII (No=16)
X2 test
P
Sig.
No
No
%
No
%
< 990 g
2
0
0
2
12.5
5.34
0.0207
S
1000-1499 g
24
15
35.7
9
56.2
17.07
0.000
HS
≥1500 g
32
27
64.3
5
31.3
2.10
0.1474
NS
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Significant correlation between lower Apgar score(Table 3) Table (3): Relation between Apgar score for infants with and without IVH: GroupI (No=42)
Groups
Score
GroupII (No=16)
Range Mean
SD±
Range Mean
T test
P
Sig.
SD±
Apgar score 1 min
2-4
3.39
±0.63
2-3
2.56
±0.53
3.59
0.0009
HS
Apgar score 5 min
3-8
7.54
±1.2
5-8
6.22
±1.2
2.85
0.0072
HS
High significant difference between groups in ventilator support,and administration of surfactant(Table 4). Table (4):Risk factors of different respiratory support in development of IVH .CPAP = continuous positive airway pressure . Groups
Resp.support
GroupI (No=42)
GroupII (No=16)
X2
P
Sig.
Nasopharyngeal CPAP
11 (26.2%)
7 (43.8%)
1.67
0.1963
NS
ventilator (SIMV)
16 (38.1%)
16 (100%)
17.95
0.0001
HS
Surfactant
1 (2.4%)
6 (37.5 %)
13.47
0.0002
HS
SIMV = synchronized intermittent mandatory ventilation.
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Males had significant higher rate IVH than females, and the rate of IVH was significantly higher in babies deliverd normally than those delivered by CS.Patients delivered outside the hospital showed significant increase rate of IVH than those delivered inside the hospital. As regard multiple births (twins and triplets )there was a statistical significant increase in IVH than single babies (Table 5). Table (5): Characters of studied groups: Groups
Group I (No=42)
total
Group II (No=16)
X2
P
Sig.
parameters Sex: Male Female MOD: NVD CS
No
%
No
%
No
%
29
50
19
65.5
10
34.5
29
50
23
79.3
6
20.6
19
32.8
11
57.9
8
42.1
39
67.2
31
79.5
8
20.5
39
67.2
30
76.9
9
23.1
19
32.8
12
63.2
7
36.8
17
100
12
70.6
5
29.4
6.48
0.01
S
9.65
0.002
HS
5.34
0.0207
S
2.24
0.0286
S
Place of delivery: In hospital Out hospital Multiple birth
MOD = Mode of delivery. CS = Cesarean section. Out = outside our hospital.
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NVD = Normal vaginal delivery. In = inside our hospital.
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There was a significant difference between groups in neonatal reflexes(Table 6). Table (6): Neurological findings at admission in the studied groups: CNS findings at admission
Group I
Group II
X2
P
Irritability
3 (7.1%)
1 (6.3%)
0.01
0.9045
Neonatal reflexes abscent Intact sluggish
5 (11.9)% 19 (45.2%) 18 (42.9%)
5 (31.3%) 2 (12.5%) 9 (56.3%)
6.39
0.0409
Seizures
1 (2.4%)
0
0.39
0.5225
There was a significant effect regarding the RD,pneumothorax and apnea on the development of IVH (Table 7). Table (7): Presenting symptoms in the studied groups:
Groups Symptom RD Pneumothorax Apnea EOS Seizures Jaundice CHD
Group I no=42)
Group II (No=16)
X2
P
Sig.
27 (64.3%)
15 (93.8%)
5.04
0.0248
S
6 (14.3%)
7 (43.8%)
5.78
0.0161
HS
4 (9.5%)
7 (43.8%)
8.83
0.0029
HS
14 (33.3%)
5 (31.3%)
0.02
0.8799
NS
1 (2.4%)
0
0.39
0.5335
NS
5 (11.9%)
0
2.08
0.1488
NS
2 (4.8%)
0
0.79
0.3743
NS
There was high significant increase in patients with bulging anterior fontanel and seizures ,also there is high significant change in neonatal reflexes(Table 8).
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Table (8):Neurological findings at admission in (group II) before and after IVH. Group II at admission (No=16)
Group II After IVH (No=16)
X2
P
Sig.
Irritability
1 (6.3%)
0
1.03
0.3173
NS
Anterior fontanel bulge
0
4 (25%)
4.43
0.0353
S
10 (62.5%) 0 6 (37.5%) 7 (43.8%)
10.93
0.0042
HS
8.68
0.0032
HS
Findings
Parameters
Neonatal reflexes: absent Intact sluggish Seizures
5 (31.3%) 2 (12.5%) 9 (56.3%) 0
Mean value of time of occurance of IVH was 4.75±1.25 days (ranging from 2 to 7 daysTable 9). Table (9): Time of detection of IVH by CUS Cases Time 2nd day 3rd to 6th day 7th day
Number
%
5 5 6
31.3 31.3 37.4
Frequency of grades of IVH by CUS showed that grade I occurred in 7 cases (43.7%) and grade III in 5 cases (31.3%)-Table 10 Table (10): CUS grades for cases with IVH: CUS grade I II III IV Total
Number of infants 7 2 5 2 16
% 43.7 12.5 31.3 12.5 100
There is a high significant difference between groups in outcome. 81.3% of IVH cases died (Table 11).
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Table (11): Outcome of infants in studied groups:
Outcome
Died Discharged
Group I (No=42)
Group II (No=16)
No
%
No
%
11 31
26.2 73.8
13 3
81.3 18.7
X2 test
P
Sig.
14.48
0.0001
HS
Fig (1): Normal cranial ultrasonographic appearance of male preterm baby at day 2 after birth: Normal brain parenchymal density with no focal lesions. No intra or extra-axial collections. No midline shift. Normal ventricular system. Normal posterior fosse structures.
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Fig (2) CUS of male baby 4 days old: Grade I IVH, Subependymal germinal matrix hemorrhage, parasagittal and coronal planes.
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Fig (3): CUS of female baby 7 days old showing grade III IVH: There was dilatation of lateral ventricle, third and forth ventricles which were full with blood bilaterally. 12
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Discussion It has been estimated that intraventricular hemorrhage is the second commonest cause of neonatal deaths after congenital anomalies and is the primary postpartum finding in 20% babies dying in neonatal period. The figure rises to 50% to 70% if one considers only premature babies. (Debillon et al., 2003) The present study aimed to studying the incidence of intraventricular hemorrhage in preterm neonates in the neonatal intensive care unit by screening all preterm neonates using cranial ultrasonography and to determine the different obstetric and neonatal risk factors associated with the development of IVH. As regard the GA it was found that there was a highly significant lower GA among cases with IVH, cases with GA ≤ 30 weeks were 12 cases (75%) & cases > 30 weeks were 4 cases (25%).This was in agreement with Dolfin et al.,( 1994) who stated that GA was an important factor associated with IVH. The incidence in infants less than or equal to 30 weeks gestation was 75%, whereas in infants greater than 30 weeks GA was 25%. The same relation was shown by Roze et al.,(2008 )Who found that the development of IVH was associated with low GA. Lee et al., (2010) found that low GA has been proposed as associated with the pathogenesis of PV-IVH. Miranda,( 2010 ) found that the incidence of IVH increases as the GA decreases. As regard birth weight it was found that there was a significant lower birth weight among patients with IVH in comparison to the patients without IVH: Two extreme low birth weight neonate out of two developed IVH (100%), 9 very low birth weight neonates out of 24 cases developed IVH (37.5%) and 5 low birth weight out of 32 developed IVH (15.6%). This finding agreed with the study done by Dykes et al., (2000 )who found that, birth weight less than or equal to 1200 gm, were associated with IVH. The same results were shown by Patra et al., (2006 )in a group of preterm babies. Khodapanahandeh et al.,(2008)reported that lower birth weight was associated with greater risk of IVH occurrence Baumert et al., (2008 )found that the birth weight in the group with IVH was lower than in the group without IVH. And also this agrees with study by Brouwer et al., (2010 ) who stated that infants with birth weight of were more liable to intraventricular hemorrhage than mature one. On studying the gender relation to IVH it was found that male gender showed a significant higher rate of IVH than female, in which 50% of total studied newborns were males, 34.5 % from them had IVH, while 50% were females, 20.6% from them had IVH
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(cases with IVH were 62.5% males & 37.5% females). This finding agreed with Dykes et al., (2000 )who found that male sex was more associated with IVH than female.ElKhodor and Boksa,( 2003 )found that preterm boys were found to be more susceptible than girls to brain injury secondary to altered catecholamine levels in their brains. It was found that among cases delivered vaginally, 42.1% developed IVH while only 20.5% of cases delivered by CS had IVH.This finding agrees with Wen et al.,( 2001) who found that there was increase risk of ICH in assisted vaginal delivery. Loony et al( 2007 ) reported that 26% of neonates delivered vaginally had ICH. In the present study there was a significant higher rate of IVH in cases delivered outside our hospital than those delivered at our hospital, this may be due to transport problems and lack of facilities together with birth trauma and instrumental deliveries. This finding agreed with Vela Huerta et al., (2009) who stated that the risk of IVH is higher in infants who are transported after birth. Mohamed et al., (2010) reported that Inter-hospital transport of VLBW infants is correlated with increased incidence and severity of IVH. As regard the Apgar score, it was found that there was a highly significant lower Apgar score at one minute and 5 minutes among cases with IVH. This finding agreed with Baumert et al., ((2008) who found that asphyxiated newborns with critically low ( 1- 4 points ) and fairly low ( 5-7 points ) Apgar score are significantly more likely to develop IVH ( twice the risk of IVH ) in comparison to babies born in good condition. Khodapanahandeh et al., (2008) reported that lower Apgar score at 5 minutes was associated with greater risk of high grade IVH. There were certain neonatal factors that were associated with increased risk of IVH, including; RDS, pneumothorax, trauma, apnea, use of ventilator or CPAP, and use of surfactant.These results agreed with those of Roze et al., (2008) who identified several neonatal risk factors for IVH including low GA, pneumothorax, asphyxia, RDS,
and
respiratory failure. In the current study it was found that the neurological signs were detected in 31.3% of cases with IVH while 68.7% were asymptomatic and discovered to have IVH through routine CUS which was done to all cases at 2nd & 7th day after birth. These findings agreed with loony et al., (2007) who found that there was high prevalence of ICH in 14
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asymptomatic newborns and ICH causes more subtle injury to the developing brain. Soul, (2012) found that GM/IVH in the preterm newborn is usually a clinically silent syndrome and is therefore recognized only when a routine CUS is performed. However, some infants present with decreased levels of consciousness and spontaneous movements, hypotonia, abnormal eye movements, or deviation.As regard clinical manifestations of cases proved to have IVH by cranial ultrasonography were: pallor (100%), jaundice (75%), weakness (75%), absent neonatal reflexes (62.5), convulsions (43.8%) and bulge anterior fontanel (25%). Rooks et al., at (2008)on studying the neurological manifestation among cases with ICH: found that as regard the level of consciousness' 66.7% were alert, 20.5% irritable, 10.3% lethargic, 2.5% comatosed. By assessing suckling reflex, 66.7 % were normal, 23% weak, and 10.3% absent.For Moro reflex 66.7% were normal, 25.6% weak, and 7.7% absent. Yilmaz et al., (2009) found that the signs and symptoms of infants with a diagnosis of ICH due to late onset vitamin K deficiency were irritability (40%), poor suckling (50%), absent neonatal reflexes (37%) and convulsions (83%). Ou-Yang et al (2010) stated that the clinical manifestations of ICH included anemia (54%), seizure (46%), cyanosis (29%), tachypnea (21%), fever (4%), hypothermia (4%) and poor feeding (4%). In our study it was found that 100% of cases of IVH were on ventilator support. Dykes et al.,( 2000 ) reported that mechanical ventilation, peak inflation pressure > 25 cm H 2O, inspiratory to expiratory ratio (I: E ratio), positive end –expiratory pressure > 5 cm H2O, were associated with IVH. These results agreed with those of Roze et al., (2008) who stated that respiratory respiratory failure and need for ventilatory support represented a neonatal risk factor for developing ICH. Khodapanahandeh et al., (2008) reported that the use of mechanical ventilation was associated with greater risk of high grade IVH occurrence. On studying frequency of different grades of IVH it was found that 43.7% had grade I, 12.5% had grade II, 31.3% had grade III, 12.5% had grade IV. This agreed with Kadri et al.,( 2006) who found that the incidence of IVH among preterm neonates was 44.68%. The majorities were mostly grade I and II. In contrast to Kliegman et al., (2008 )who stated that grade I = 35% of IVH cases, grade II = 40 % of IVH cases. Lee et al., (2010) 15
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found that 79.7% with grade I IVH, 6.9% grade II, 4.8 % grade III and 8.6 % grade IV. Sajjadian et al., (2010) found that 40% of patients with GM-IVH had grade I, 11% grad II, 25.7% grade III and 2.8% grade IV. Our results showed that the time of detection of IVH by CUS were as follows, 31.3 % of cases of IVH were discovered in the 2nd day of life, 37.4% discovered on 7th day of life and 31.3% were appeared from 3rd to 6th day, with mean value of 4.75 ± 1.25 days. This finding were agreed with Kadri et al., (2006) reported that the majorities of IVH occurred in the first 7 days of life. In contrast to Hellstrom-Westas et al.,( 2001)who stated that postnatally, most hemorrhage occur when the neonate is younger than 72 hours, with 50% of IVH occurring on the first day of life. The extent of hemorrhage is greatest when the neonate is aged approximately 5 days. IVH can occur when the individual is older than 3 days, especially if a significant life-threatening illness arises. Volpe, (2008 )stated that GM-IVH in premature infants is typically diagnosed during the first days of life, 50% on the first day and 90 % within the first 4 days, between 20 % and 40 % of these infants undergo progression of hemorrhage during these first days of life. Khodapanahandeh et al., (2008) reported that 80 % -90 % of cases of IVH occurred between birth and the third day of life of VLBW. Conclusion The above presented data disclosed the fact that IVH was still an important problem facing premature infants leading to higher mortality rate among them. Preterm with lower GA & VLBW are at greater risk of developing IVH. The risk of IVH is higher in infants who are transported after birth and delivered outside of the hospitals. The relation between IVH and obstetric and neonatal risk factors open new therapeutic and preventive aspect in this field. The cranial ultrasonography is very helpful tool in the early diagnosis of IVH. CUS is a quick, reliable, and safe diagnostic modality, which can be performed at bed side and can be considered as a specific and sensitive indicator for occurrence of IVH.
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Vol.41(4),October,2012,887-901
AL-Azhar Med,J.
معدل حدوث النزيف المخي البطيني في األطفال الخدج المحجوزين في وحدة الرعاية المركزة لألطفال حديثي الوالدة بمستشفى سيد جالل الجامعي عاطف السيد دنيا * -حسن علي حسن*-عبد النبي بيومي محمد**-محمد محمد فهمى***-محمد أمين محمد جبريل*-إبراهيم محمد عبد الغني* أقسام األطفال*واالشعة ** وطب المجتمع ***-كلية طب األزهر –القاهرة هذا البحث يتعلق بالنزيف المخي البطيني عند األطفال الخدج حديثي الوالدة ال يزال النزيف المخي البطيني عامال رئيسيا في وفاة وإصابة االطفال الخدج حديثي الوالدة بالكثير من المضاعفات بل احد االسباب الرئيسية في اإلعاقة الذهنية لدى هؤالء األطفال لذا كان الهدف الرئيسي من هذه الدراسة هو دراسة معدل حدوث النزيف المخي البطيني في االطفال الخدج الين تم حجزهم بوحدة الرعاية ال مركزة لالطفال حديثي الوالدة بمستشفى باب الشعرية الجامعي والكشف المبكر عن هذا النزيف دون حدوث اي اعراض عصبية ودراسة العوامل المؤثرة في حدوث هذا النزيف. وقد تمت هذه الدراسة بوحدة االطفال حديثي الوالدة بمستشفى باب الشعرية الجامعي من أول شهر اكتوبر 2011 وحتي نهاية شهر مارس 2012وشملت 58طفال تتراوح أعمارهم الرحمية من 28الى 34اسبوعا وتتراوح اوزانهم بين 900الي 2780جراما نصفهم ذكور ونصفهم إناث وتمت متابعتهم أثناء فترة الحجز بالوحدة لرصد حاالت النزيف المخي البطيني من اليوم الثاني إلي اليوم السابع عن طريق عمل موجات صوتية علي المخ مع عمل الموجات الص وتية يوميا للحاالت المشكوك في اصابتها بالنزيف وقد تم عمل اآلتي لالطفال موضع الدراسة: -1التاريخ المرضي التفصيلي لالم اثتاء الحمل وعند الوالدة وبعد الوالدة -2تقييم العمر الرحمي باستخدام مقياس باالرد -3وزن الطفل عند الوالدة -4الك شف االكلينيكي الشامل وعلى االخص الكشف على الجهاز العصبي يوميا -5عمل الموجات فوق الصوتية على المخ في اليوم الثاني والسابع من العمر -6فحوصات معملية روتينية مثل صورة دم كاملة -غازات الدم -عوامل النزف والتجلط -و الصفراء بالدم وقد أسفرت هذه الدراسة عن النتائج االتية:
وجد ان نسبة حدوث النزيف المخي البطيني 16(%27.6حالة من بين 58حالة شملتهم الدراسة)
اظهرت هذه الدراسة زيادة عدد الحاالت المصابة بنزيف المخ البطيني في االطفال الذين تقل اعمارهم الرحمية عن 30اسبوعا وواوزانهم اقل من 1500جراما
كما لوحظ زيادة عدد الحاالت المصابة بهذا النزيف في الذكور حيث كان عددهم 10حاالت من )%34.5( 29بينما كان عدد اإلناث هو 6حاالت فقط من )20.7%( 29 20
Vol.41(4),October,2012,887-901
AL-Azhar Med,J.
كما تبين زيادة عدد الحاالت المصابة بهذا النزيف في األطفال الذين ولدوا والدة طبيعية عن االطفال الذين ولدوا والدة قيصرية وكذا في األطفال الذين ولدوا خارج المستشفي وتم نقلهم الى المستشفى عن االطفال الذين تمت والدتهم في المستشفى وذلك للمشاكل المتعلقة بالنقل.
زيادة الحاالت المصابة بنزيف المخ البطيني في االطفال تحت ج هاز التنفس الصناعي
بينت أهمية الموجات فوق الصوتية على المخ لألطفال الخدج في الكشف المبكر عن وجود النزيف المخي البطيني
أظهرت الدراسة أن نسبة الحاالت المصابة التي ظهرت في اليوم الثاني كانت ()31.3% والحاالت التي ظهرت في اليوم السابع كانت ( )37.4%وظهرت باقي الحاالت في الفترة من اليوم الثالث الي اليوم السابع
ارتفاع نسبة الوفيات في الحاالت المصابة بالنزيف الى( )81.3%
الخالصة :
النزيف المخي البطيني ال يزال مشكلة رئيسية تواجه االطفال الخدج خصوصا الذين تقل اعمارهم الرحمية عن 30اسبوعا وتقل أوزانهم عن 1500جراما
زيادة النزيف المخي البطيني في األطفال الخدج الذين يتم نقلهم بعد الوالدة إلى مراكز الوحدات المركزة لحديثي الوالدة
أهمية الفحص بالموجات فوق الصوتية على المخ لألطفال الخدج في األيام األولى من العمر
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