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Intraventricular Hemorrhage in Moderate to Severe Congenital Heart Disease

Ortinau, Cynthia, M., MD1; Anadkat, Jagruti, S., MD1; Smyser, Christopher, D., MD1,2,3; Eghtesady, Pirooz, MD, PhD4

Pediatric Critical Care Medicine: January 2018 - Volume 19 - Issue 1 - p 56–63
doi: 10.1097/PCC.0000000000001374
Neurocritical Care
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Objectives: Determine the prevalence of intraventricular hemorrhage in infants with moderate to severe congenital heart disease, investigate the impact of gestational age, cardiac diagnosis, and cardiac intervention on intraventricular hemorrhage, and compare intraventricular hemorrhage rates in preterm infants with and without congenital heart disease.

Design: A single-center retrospective review.

Setting: A tertiary care children's hospital.

Patients: All infants admitted to St. Louis Children's Hospital from 2007 to 2012 with moderate to severe congenital heart disease requiring cardiac intervention in the first 90 days of life and all preterm infants without congenital heart disease or congenital anomalies/known genetic diagnoses admitted during the same time period.

Interventions: None.

Measurements and Main Results: Cranial ultrasound data were reviewed for presence/severity of intraventricular hemorrhage. Head CT and brain MRI data were also reviewed in the congenital heart disease infants. Univariate analyses were undertaken to determine associations with intraventricular hemorrhage, and a final multivariate logistic regression model was performed. There were 339 infants with congenital heart disease who met inclusion criteria and 25.4% were born preterm. Intraventricular hemorrhage was identified on cranial ultrasound in 13.3% of infants, with the majority of intraventricular hemorrhage being low-grade (grade I/II). The incidence increased as gestational age decreased such that intraventricular hemorrhage was present in 8.7% of term infants, 19.2% of late preterm infants, 26.3% of moderately preterm infants, and 53.3% of very preterm infants. There was no difference in intraventricular hemorrhage rates between cardiac diagnoses. Additionally, the rate of intraventricular hemorrhage did not increase after cardiac intervention, with only three infants demonstrating new/worsening high-grade (grade III/IV) intraventricular hemorrhage after surgery. In a multivariate model, only gestational age at birth and African-American race were predictors of intraventricular hemorrhage. In the subset of infants with CT/MRI data, there was good sensitivity and specificity of cranial ultrasound for presence of intraventricular hemorrhage.

Conclusions: Infants with congenital heart disease commonly develop intraventricular hemorrhage, particularly when born preterm. However, the vast majority of intraventricular hemorrhage is low-grade and is associated with gestational age and African-American race

1Department of Pediatrics, Washington University in St. Louis, St. Louis, MO.

2Department of Neurology, Washington University in St. Louis, St. Louis, MO.

3Department of Radiology, Washington University in St. Louis, St. Louis, MO.

4Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis, MO.

This work was performed at Washington University in St. Louis, St. Louis, MO.

Supported, in part, by the Washington University Institute of Clinical and Translational Sciences (UL1 TR000448 and KL2 TR000450) from the National Center for Advancing Translational Sciences, the Children’s Discovery Institute of Washington University and St. Louis Children’s Hospital, and the National Institutes of Health/National Institutes of Neurological Disorders and Stroke (K02 NS089852).

Dr. Ortinau’s institution received funding from the National Institutes of Health (NIH)/Institute of Clinical and Translational Sciences (UL1 TR000448 and KL2 TR 000450) and the Children’s Discovery Institute, and she received support for article research from the NIH and Children’s Discovery Institute. Dr. Smyser’s institution received funding from the NIH/National Institutes of Neurological Disorders and Stroke (K02 NS089852), and he received support for article research from the NIH and Children’s Discovery Institute. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: ortinau_c@kids.wustl.edu

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies