Incidence of intraventricular haemorrhage in very low-birthweight infants in a group of private hospitals in Johannesburg, South Africa, 2018 - 2022

Background. Intraventricular haemorrhage (IVH) is a common complication among very low-birthweight infants (VLBWIs), affecting ~20 - 30% of VLBWIs. Most published reports on the incidence of IVH in South Africa (SA) come from public sector hospitals, with few studies having been conducted in private sector hospitals. Objectives. To determine the incidence of IVH and factors associated with moderate to severe IVH in VLBWIs admitted to private sector hospitals. Methods. This was a retrospective study of VLBWIs admitted to neonatal intensive care units in three private hospitals in Johannesburg, SA, from 2018 to 2022. The study was a secondary analysis of data provided by the Vermont Oxford Network. VLBWIs admitted in three hospitals that gave permission for their data to be used were analysed. Incidence was determined based on all VLBWIs who had cranial ultrasound scans performed during admission. Comparisons were performed between VLBWIs with normal findings or mild IVH and those with moderate to severe IVH. Results. A total of 186 VLBWIs were admitted to the three private hospitals during the study period, of whom 135 (72.6%) had cranial ultrasound scans performed. Of these VLBWIs, 34 had some degree of IVH and 18 had moderate to severe IVH, giving an incidence of 25.2% for any IVH and 13.3% for moderate to severe IVH. The odds of having moderate to severe IVH were lower if birth was via caesarean section (CS) v. vaginal (adjusted odds ratio (aOR) 0.09; 95% confidence interval (CI) 0.02 - 0.45; p=0.004) and gestational age was ≥28 weeks (aOR 0.08; 95% CI 0.01 - 0.86; p=0.037), while odds were higher for neonates born to mothers who received antenatal magnesium sulphate (aOR 8.60; 95% CI 1.64 - 44.87; p=0.011). Conclusion. The incidence of IVH in VLBWIs admitted to certain private hospitals was comparable to the incidence reported in high- income countries. The odds of VLBWIs having moderate to severe IVH were lower when infants were born by CS or were of higher gestational age, but higher if the mother received antenatal magnesium sulphate. Although routine CS cannot be recommended for delivery of VLBWIs based on the study findings, as we did not review the indications for CS, some VLBWIs may benefit from being delivered by CS. The unexpected finding of magnesium sulphate being associated with high odds of moderate to severe IVH needs to be studied further.