A1 Refereed original research article in a scientific journal
International Variation and Trends of Intraventricular Hemorrhage in Very Preterm Infants
Authors: Hollens, Georgia; Schindler, Tim; Battin, Malcolm; Klinger, Gil; Adams, Mark; Vento, Maximo; Santacroce, Antonino; Hakansson, Stellan; Isayama, Tetsuya; Norman, Mikael; Kusuda, Satoshi; Lehtonen, Liisa; Helenius, Kjell; Modi, Neena; Shah, Prakesh S.; Lui, Kei; iNeo Neonatal Network
Publisher: S. Karger AG
Publishing place: BASEL
Publication year: 2025
Journal: Neonatology
Journal name in source: Neonatology
Journal acronym: NEONATOLOGY
Number of pages: 16
ISSN: 1661-7800
eISSN: 1661-7819
DOI: https://doi.org/10.1159/000546714
Web address : https://doi.org/10.1159/000546714
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/499390317
Introduction: We aimed to investigate international variation in gestational age (GA) specific severe intraventricular hemorrhage (IVH) rates, among infants of <30 weeks' GA from the neonatal networks of 11 high-income countries/region.
Methods: Retrospective cohort study of outcomes of grade 3/4 IVH rates and composite of g3/4 IVH or death in GA groups of 22-23, 24-25, 26-27, and 28-29 weeks infants admitted to networks of Australia and New Zealand, Canada, Finland, Israel, Italy (Tuscany), Japan, Spain, Sweden, Switzerland, and the UK. Their risk adjusted trends across 3 epochs (2007-11, 2012-15, and 2016-19) were also evaluated.
Results: Outcomes of 165,329 infants (median GA 27 weeks, birthweight 950 g) were analyzed. Overall, the lowest grade 3/4 IVH rate was observed in Japan (6.4%) and the highest in Israel (16.1%). The overall gestation-specific rate of IVH grade 3/4 were 25.8%, 18.6%, 9.0%, and 3.8% and composite outcome of grade 3/4 IVH/death rates 52.2%, 33.6%, 15.6%, and 6.7% for the 22-23, 24-25, 26-27, and 28-29 weeks' GA groups, respectively. These inter-network variations were greater at lower GA. In epoch comparisons, almost all networks showed significant decreases in GA specific composite outcome rates, particularly in the 26-27 week' GA group. Japan and Canada demonstrated significant decreases in each GA group while Spain demonstrated significant decreases in each GA group except for 22-23 weeks' gestation.
Conclusions: Rates of grade 3/4 IVH and composite outcome rates varied internationally and have decreased over time. Identification of the driving factors behind variations may allow for opportunities for practice review and improvement.
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Funding information in the publication:
The International Network for Evaluating Outcomes of Neo-nates (iNeo) has been supported by the Canadian Institutes of Health Research (APR-126340 and PBN 150642 to P.S.S.). TheAustralian and New Zealand Neonatal Network are predomi-nantly funded by membership contributions from the partici-pating centers. The Canadian Neonatal Network is supported by ateam grant from the Canadian Institutes of Health Research (CTP87518), and by the participating centers. The Finnish MedicalBirth Register is governmentally funded and kept by the NationalInstitute for Health and Welfare (THL). The Israel NeonatalNetwork very low birth weight infant database is partially fundedby the Israel Center for Disease Control and the Ministry ofHealth. The Neonatal Research Network of Japan is partly fundedby a Health Labour Sciences Research Grant from the Ministry of Health, Labour, and Welfare of Japan. The Spanish NeonatalNetwork is supported by funds from the Spanish Neonatal Society(SENeo). The Swedish Neonatal Quality Register is funded by theSwedish Government (Ministry of Health and Social Affairs), theSwedish Association of Local Communities and Regions (SALAR)and the participating units. The Swiss Neonatal Network is par-tially funded by the participating units in the form of membershipfees. Tuscany Neonatal Network is funded by the Tuscany Region.The United Kingdom Neonatal Collaborative receives no corefunding. This research was also supported by Instituto de In-vestigacion Sanitaria Carlos III (Ministry of Science, Innovationand Universities, Kingdom of Spain) (FIS17/0131 to M.V.); andRETICS funded by the PN 2018-2021 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion,and the European Regional Development Fund (ERDF) (RD16/0022); and by grants from a regional agreement on clinical re-search (ALF) between Region Stockholm and Karolinska Institutet(2020-0443 to M.N.). The funding bodies played no role in thedesign or conduct of the study; the collection, management,analysis, or interpretation of the data; the preparation, review, orapproval of the manuscript; or the decision to submit the man-uscript for publication.
