ĐẶC ĐIỂM DỊCH TỄ, LÂM SÀNG, CẬN LÂM SÀNG VÀ ĐIỀU TRỊ CỦA XUẤT HUYẾT TRONG – QUANH NÃO THẤT Ở TRẺ SINH NON DƯỚI 32 TUẦN TUỔI THAI

Abstract

Background: Periventricular–intraventricular hemorrhage (PIVH) is a common complication in preterm infants, especially those born before 32 weeks of gestation. This condition may lead to significant mortality or long-term neurological sequelae. Objectives: To describe the epidemiological, clinical, paraclinical characteristics, and treatments of PIVH in preterm infants under 32 weeks of gestational age. Methods: A cross-sectional descriptive study was conducted on 50 preterm infants below 32 weeks of gestation at Children's Hospital 2 from September 2024 to February 2025. Cranial ultrasound was performed at three time points (within 72 hours after birth, at 7–14 days, and at 4–6 weeks of age) to diagnose PIVH, and severity was classified according to Papile’s classification modified by Volpe. Results: The incidence of PIVH was 36%, with mild hemorrhage (grades I-II) comprising 28% and severe hemorrhage (grades III-IV) accounting for 8%. Infants with severe PIVH had lower mean gestational age (25.5 weeks) and birth weight (920 g) compared to mild cases (28.25 weeks, 1227.9 g) and non-PIVH cases (29 weeks, 1246.3 g). Risk factors, including multiple gestations, premature rupture of membranes, maternal fever during labor, and incomplete antenatal Corticosteroid therapy, were more frequent in the hemorrhage groups. All infants with severe PIVH were born via vaginal delivery, and most (75%) required intensive resuscitation with endotracheal intubation. Clinical conditions such as respiratory distress syndrome, early-onset sepsis, patent ductus arteriosus, pneumonia, anemia, thrombocytopenia, and metabolic acidosis were more frequently observed in infants with severe PIVH. All severe cases required invasive mechanical ventilation (>3 days), Surfactant therapy, Fentanyl, and Paracetamol for patent ductus arteriosus closure. The mortality rate was higher among infants with severe PIVH (25%) compared to those with mild PIVH (7.1%) and those in the non-PIVH group (6.3%). Conclusion: The incidence of intraventricular hemorrhage (IVH) remains relatively high in preterm infants born before 32 weeks' gestation. Severe IVH primarily affects infants with extremely low gestational age and very low birth weight. Additionally, these infants often have inadequate prenatal corticosteroid prophylaxis and frequently experience multiple clinical and laboratory abnormalities, contributing to significantly higher mortality rates.