Effect of maternal tocolysis on the incidence of severe periventricular/intraventricular haemorrhage in very low birthweight infants.
OBJECTIVE
To examine the relation between grade III-IV periventricular/intraventricular haemorrhage (PVH/IVH) and antenatal exposure to tocolytic treatment in very low birthweight (VLBW) premature infants.


METHODS
The study population consisted of 2794 infants from the Israel National VLBW Infant Database, of gestational age 24-32 weeks, who had a cranial ultrasound examination during the first 28 days of life. Infants of mothers with pregnancy induced hypertension or those exposed to more than one tocolytic drug were excluded. Of the 2794 infants, 2013 (72%) had not been exposed to tocolysis and 781 (28%) had been exposed to a single tocolytic agent. To evaluate the effect of tocolysis and confounding variables on grade III-IV PVH/IVH, the chi(2) test, univariate analysis, and a logistic regression model were used.


RESULTS
Of the 781 infants (28%) exposed to tocolysis, 341 (12.2%) were exposed to magnesium sulphate, 263 (9.4%) to ritodrine, and 177 (6.3%) to indomethacin. The overall incidence of grade III-IV PVH/IVH was 13.4%. In the multivariate logistic regression analysis, the following factors were related significantly and independently to grade III-IV PVH/IVH: no prenatal steroid treatment, low gestational age, one minute Apgar score 0-3, respiratory distress syndrome, patent ductus arteriosus, mechanical ventilation, and pneumothorax. Infants exposed to ritodrine tocolysis (but not to the other tocolytic drugs) were at significantly lower risk of grade III-IV PVH/IVH after adjustment for other variables (odds ratio = 0.3; 95% confidence interval 0.2 to 0.6).


CONCLUSIONS
This study suggests that antenatal exposure of VLBW infants to ritodrine tocolysis, in contrast with tocolysis induced by magnesium sulphate or indomethacin, was associated with a lower incidence of grade III-IV PVH/IVH.
Weintraub
Z
Z
Neonatal Department, Carmel Medical Center, 7 Michael Street, Haifa 34362, Israel. wzalman@techunix.technion.ac.il
Solovechick
M
M
Reichman
B
B
Rotschild
A
A
Waisman
D
D
Davkin
O
O
Lusky
A
A
Bental
Y
Y
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001034:Apgar Score; D004374:Ductus Arteriosus, Patent / Q000150:complications; D005260:Female; D005865:Gestational Age; D006801:Humans; D007213:Indomethacin / Q000009:adverse effects; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D020300:Intracranial Hemorrhages / Q000139:chemically induced*; D016015:Logistic Models; D008278:Magnesium Sulfate / Q000009:adverse effects; D015999:Multivariate Analysis; D011030:Pneumothorax / Q000150:complications; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications; D012307:Risk Factors; D012312:Ritodrine / Q000009:adverse effects; D013256:Steroids; D015149:Tocolytic Agents / Q000009:adverse effects*
D000893:Anti-Inflammatory Agents; D013256:Steroids; D015149:Tocolytic Agents; D008278:Magnesium Sulfate; D012312:Ritodrine; D007213:Indomethacin