Should preterm infants born after 29 weeks' gestation be screened for intraventricular haemorrhage?
OBJECTIVE
To determine whether the current incidence of intraventricular haemorrhage (IVH) of grade 2 or more is high enough in preterm infants born after 29 weeks gestation to justify the cost of screening with ultrasound and to explore clinical indicators for risk of IVH in the more mature preterm infant.


METHODS
This cohort study examined the incidence and severity of IVH in 800 preterm infants born between January 1992 and August 1996, of whom 436 were born after 29 weeks. Demographic and clinical details were collected from a prospectively maintained database. The Medicare schedule charge rate for cerebral ultrasound was used to calculate costs.


RESULTS
1.1% of preterm babies born after 29 weeks gestation who had routine ultrasound scans had an IVH of grade 2 or 3, no infant had a grade 4 IVH. Two infants had a grade 3 IVH, both of which were symptomatic. IVH was poorly predicted by other clinical criteria. Using the Medicare schedule to estimate costs, detecting the five grade 2 or 3 IVH cost A$42,000.


CONCLUSIONS
The incidence of grade 2-4 IVH is low in infants born after 29 weeks gestation. Screening of this population is expensive and probably not justified. It may be most appropriate to scan these infants only if their condition raises concern.
Harding
D
D
Department of Neonatal Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
Kuschel
C
C
Evans
N
N
D001315:Australia; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015997:Neonatal Screening / Q000191:economics; D012307:Risk Factors; D012720:Severity of Illness Index; D014463:Ultrasonography / Q000191:economics