Fatores associados a hemorragia intracraniana em neonatos prematuros: estudo caso-controle

Abstract

Intracranial hemorrhage (ICH) is a complex and multifactorial disorder, the main pathogenic mechanisms of which are disorders of cerebral blood flow, inherent fragility of the germinal matrix vasculature, and platelet and coagulation disorders. The aim of the present study was to verify factors associated with the occurrence of Intracranial Hemorrhages in preterm infants undergoing hospitalization in the Intensive Care Unit. This is a case-control exploratory study to investigate the role of several factors associated with the development of ICH in preterm neonates, investigated maternal and prenatal variables, perinatal variables, and neonatal variables. We studied 150 preterm infants with gestational age <34 weeks who underwent transfontanel ultrasound examination, who were admitted to the Neonatal Intensive Care Unit from January 2014 to July 2017, in a public hospital in the south of the state of Minas Gerais. We selected 59 premature neonates who had a diagnosis of intracranial hemorrhage for the Case Group and 91 preterm neonates who presented normal examination as the control group. For the univariate analysis, the chi-square test was used and those variables that presented p <0.50 were inserted into the logistic regression model. The measure of association considered was odds ratio (OR), with a 95% confidence interval (95% CI) and a statistical significance level of 5%. Of the total sample of 150 preterm infants, 77 (51.3%) were males, mean gestational age was 30.36 ± 2.92 weeks, and 1517.44 ± 597 grams at birth, HIC degree I was the most frequent (45.8%). In the univariate analysis, low gestational age (p: 0.0183), low birth weight (p: 0.0050), need for exogenous surfactant (p: 0.0004), need for orotracheal intubation (p: 0.0024), such as perinatal and (p: 0.0000), very low birth weight (p: 0.0016), early sepsis (p: 0189), late sepsis (p: (P 0.0000), neonatal anemia (p: 0.0183), Persistence of ductus arteriosus, use of invasive ventilatory support (p: 0.0016), oxygen therapy (p: 0.0070), thrombocytopenia (p: 0.0004). By regression analysis, only neonatal variables such as the Apgar Score 5 "lower than 6 (OR 3.92 / p: 0.0174) and need for surfactant administration (OR 3.59 / p: 0.0011) were associated with ICH, the significant perinatal variables (OR 4.66 / p: 0.0006) and thrombocytopenia (OR 6.93 / p: 0.0040); maternal and prenatal variables were not associated with ICH occurrence. It can be concluded that the perinatal factors associated with intracranial hemorrhage in preterm infants were the need for surfactant administration and score in the 5-minute Apgar test of less than six. Maternal and prenatal variables were not associated with ICH in PTNB. The need for administration of vasoactive drugs and thrombocytopenia were associated with the occurrence of ICH, when other perinatal variables were controlled. Moreover, the recognition of these factors of association becomes important to reinforce the criteria of choice and the therapeutic behaviors in the care with the neonate, as well as in the management, with the intention of prevention.