Timing of intraventricular hemorrhage in preterm infants less than 32 weeks of gestational age

Abstract

OBJECTIVES: Intraventricular hemorrhage (IVH) remains a major challenge in preterm infants, with its exact timing and periods of greatest risk still debated. This study aims to describe the timing, incidence, severity, and risk factors for IVH in preterm infants born before 32 weeks' gestation. METHODS: A prospective observational study of 182 preterm infants (<32 weeks) was conducted in a tertiary neonatal intensive care unit. Standardized cranial ultrasounds were performed at 0-6, 6-24, 24-48, and 48-96 h post-birth and graded via Papile criteria. Maternal and neonatal associations with IVH were analyzed. RESULTS: IVH incidence was 17 % (31/182), predominantly mild (80.7 %), while severe cases comprised 19.4 %. Almost half of the events (45 %) occurred within the first 6 h, followed by a second peak between days 2 and 4. While univariate analysis linked several immaturity and illness markers to IVH, multivariate models identified invasive ventilation as the sole independent predictor (adjusted OR 3.99, p=0.004). CONCLUSIONS: IVH in very preterm infants occurs predominantly in the first hours after birth, with a subsequent risk window between 2 and 4 days. Invasive ventilation is the strongest independent risk factor, emphasizing the need for protective respiratory care. Early and ongoing ultrasound screening remains essential for timely diagnosis.