Frequent handling in the neonatal intensive care unit and intraventricular hemorrhage.
The association between periventricular-intraventricular hemorrhage (PV-IVH) and frequent handling resulting from various neonatal intensive care procedures and routine interventions was evaluated in a prospective clinical study. Inborn premature babies with birth weight less than or equal to 1500 gm (n = 156) who did not have PV-IVH or who had grade 1 PV-IVH at less than or equal to 1 hour were randomly assigned to the reduced manipulation protocol (n = 62) or to standard care (n = 94). A bedside microcomputer-based data acquisition system was used to monitor the duration of rest or the number of interventions per day. Infants assigned to receive reduced manipulation spent a significantly higher percentage of time each day at rest than did those who received standard manipulation (p less than 0.006). However, the incidence of grades 2 to 4 PV-IVH did not differ significantly (30% in the study vs 37% in the standard manipulation group). When we analyzed the effect of manipulation in relation to risk of PV-IVH, while taking into account other perinatal variables, standard manipulation was not associated with increased risk of grades 2 to 4 PV-IVH. However, low birth weight, maternal smoking, general anesthesia, early grade 1 PV-IVH, low hematocrit, lowest arterial oxygen pressure within the first 6 hours of life, and large base deficit at 6 hours of age all increased the relative risk of grades 2 to 4 PV-IVH.
Bada
H S
HS
Department of Pediatrics, University of Tennessee, Memphis.
Korones
S B
SB
Perry
E H
EH
Arheart
K L
KL
Pourcyrous
M
M
Runyan
J W
JW
Anderson
G D
GD
Magill
H L
HL
Fitch
C W
CW
Somes
G W
GW
D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000453:epidemiology*; D002552:Cerebral Ventricles / Q000473:pathology; D006400:Hematocrit; D006801:Humans; D015994:Incidence; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D016017:Odds Ratio; D011446:Prospective Studies; D011897:Random Allocation; D012044:Regression Analysis; D013714:Tennessee / Q000453:epidemiology; D013997:Time Factors; D014463:Ultrasonography