ORIGINAL ARTICLE

¹ Department of Neonatal Medicine, Royal Prince Alfred Hospital and University of Sydney, NSW 2050, Australia
² Centre for Perinatal Health Services Research, University of Sydney
³ Department of Public Health and Community Medicine, University of Sydney

Correspondence to:
Correspondence to:
Dr N Evans, Department of Neonatal Medicine, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050 Australia:
nevans{at}med.usyd.edu.au

Background: In 1995, large differences were identified in rates of grade 3–4 intraventricular/periventricular haemorrhage (major IVH) among neonatal intensive care units (NICUs) in the Australian and New Zealand Neonatal Network.

Aims: To develop a predictive model for major IVH in order to allow risk adjustment for the variation in rates of major IVH among NICUs.

Methods: Rates of IVH were determined in 5712 infants of 24–30 weeks gestation born from 1995 to 1997. Significant antenatal and perinatal variables for major IVH in 1995 and 1996 were identified by univariate and multivariate analysis. A predictive model was developed and then validated on 1997 data.

Results: Rates of all grades of IVH fell from 1995 to 1997 (30.4 to 24.3%) but wide interunit variation remained. Seven antenatal and perinatal characteristics had significant association with major IVH: fetal distress, intrauterine growth restriction (protective), antenatal corticosteroids (protective), gestational age, 1 minute Apgar <4, male gender, and transfer after birth. A predictive model based on the last five of these variables was developed using data from 1995 and 1996 which gave an area under the receiver operator characteristic (ROC) curve of 0.76. This model was then validated on the 1997 dataset where an identical ROC curve resulted.

Conclusions: Antenatal and perinatal factors are important in the pathogenesis of major IVH. The predictive model developed from these factors can be used to adjust for confounders in interunit outcome comparison.

Keywords: intraventricular haemorrhage; epidemiology; antenatal corticosteroids; fetal distress; intrauterine growth retardation; gestational age

Abbreviations: ANZNN, Australian and New Zealand Neonatal Network; IUGR, intrauterine growth restriction; IVH, intraventricular haemorrhage; NICU, neonatal intensive care unit; PIH, pregnancy induced hypertension; PROM, prolonged rupture of membranes; ROC, receiver operator characteristic

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Georgiadis, P., Xu, H., Chua, C., Hu, F., Collins, L., Huynh, C., LaGamma, E. F., Ballabh, P. (2008). Characterization of Acute Brain Injuries and Neurobehavioral Profiles in a Rabbit Model of Germinal Matrix Hemorrhage. Stroke 39: 3378-3388 [Abstract] [Full Text]  
• Braun, A., Xu, H., Hu, F., Kocherlakota, P., Siegel, D., Chander, P., Ungvari, Z., Csiszar, A., Nedergaard, M., Ballabh, P. (2007). Paucity of Pericytes in Germinal Matrix Vasculature of Premature Infants. J. Neurosci. 27: 12012-12024 [Abstract] [Full Text]  
• Henderson-Smart, D J, Hutchinson, J L, Donoghue, D A, Evans, N J, Simpson, J M, Wright, I, for the Australian and New Zealand Neonatal Networ, (2006). Prenatal predictors of chronic lung disease in very preterm infants. Arch. Dis. Child. Fetal Neonatal Ed. 91: F40-F45 [Abstract] [Full Text]  
• Harris, D L, Teele, R L, Bloomfield, F H, Harding, J E, on behalf of the Australian and New Zealand Neonat, (2005). Does variation in interpretation of ultrasonograms account for the variation in incidence of germinal matrix/intraventricular haemorrhage between newborn intensive care units in New Zealand?. Arch. Dis. Child. Fetal Neonatal Ed. 90: F494-F499 [Abstract] [Full Text]  
• Simpson, J M, Evans, N, Gibberd, R W, Heuchan, A M, Henderson-Smart, D J (2003). Analysing differences in clinical outcomes between hospitals. Qual Saf Health Care 12: 257-262 [Abstract] [Full Text]  
• Counsell, S. J., Allsop, J. M., Harrison, M. C., Larkman, D. J., Kennea, N. L., Kapellou, O., Cowan, F. M., Hajnal, J. V., Edwards, A. D., Rutherford, M. A. (2003). Diffusion-Weighted Imaging of the Brain in Preterm Infants With Focal and Diffuse White Matter Abnormality. Pediatrics 112: 1-7 [Abstract] [Full Text]