Effect of maternal tocolysis on the incidence of severe periventricular/intraventricular haemorrhage in very low birthweight infants
Z Weintrauba, M Solovechicka, B Reichmanb, A Rotschilda, D Waismana, O Davkina, A Luskyb, Y Bentala, in collaboration with the Israel Neonatal Network
a Neonatal Department,
Carmel Medical Center, Haifa, Israel, b Health Services Research
Institute, Ministry of Health, Gertner Institute, Tel Hashomer, Israel
Correspondence to: Dr Weintraub, Carmel Medical Center, 7 Michael Street, Haifa 34362, Israel wzalman{at}techunix.technion.ac.il
Accepted 30 January
2001
AIM
To examine the
relation between grade III-IV periventricular/intraventricular
haemorrhage (PVH/IVH) and antenatal exposure to tocolytic treatment in
very low birthweight (VLBW) premature infants.
STUDY DESIGNThe study
population consisted of 2794 infants from the Israel National VLBW
Infant Database, of gestational age 24-32 weeks, who had a cranial
ultrasound examination during the first 28 days of life. Infants of
mothers with pregnancy induced hypertension or those exposed to more
than one tocolytic drug were excluded. Of the 2794 infants, 2013 (72%)
had not been exposed to tocolysis and 781 (28%) had been exposed to a
single tocolytic agent. To evaluate the effect of tocolysis and
confounding variables on grade III-IV PVH/IVH, the 
2
test, univariate analysis, and a logistic regression model were used.
RESULTSOf the 781 infants (28%) exposed to tocolysis, 341 (12.2%) were exposed to
magnesium sulphate, 263 (9.4%) to ritodrine, and 177 (6.3%) to
indomethacin. The overall incidence of grade III-IV PVH/IVH was
13.4%. In the multivariate logistic regression analysis, the following
factors were related significantly and independently to grade III-IV
PVH/IVH: no prenatal steroid treatment, low gestational age, one minute
Apgar score 0-3, respiratory distress syndrome, patent ductus
arteriosus, mechanical ventilation, and pneumothorax. Infants exposed
to ritodrine tocolysis (but not to the other tocolytic drugs) were at
significantly lower risk of grade III-IV PVH/IVH after adjustment for
other variables (odds ratio = 0.3; 95% confidence interval 0.2 to
0.6).
CONCLUSIONThis study
suggests that antenatal exposure of VLBW infants to ritodrine
tocolysis, in contrast with tocolysis induced by magnesium sulphate or
indomethacin, was associated with a lower incidence of grade III-IV
PVH/IVH.
Keywords: periventricular haemorrhage; intraventricular haemorrhage; very low birthweight; tocolytics
© 2001 by Archives of Disease in Childhood
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