Divergent risk factors for cerebellar and intraventricular hemorrhage

OBJECTIVE: To identify whether intraventricular hemorrhage (IVH) and cerebellar hemorrhage (CH) have common or divergent risk factors. STUDY DESIGN: This is a retrospective cross-sectional cohort of infants including all infants born <30 weeks from 2007–16. Comprehensive perinatal, and clinical factors were extracted from the medical record. Outborn infants, infants with major congenital anomaly, those transferred prior to discharge, and those with mixed or no brain injury were excluded. The remaining infants were divided into two groups: IVH only and cerebellar hemorrhage only. Continuous variables were evaluated with the Wilcoxon-Mann-Whitney Test, categorical variables were evaluated with Fisher’s Exact Test. Multinomial logistic regression was used to identify factors which predispose infants towards injury type more than another, holding other factors held constant. RESULTS: 127 infants were included (CH n=27, IVH n=100). Compared to those with IVH, infants with CH were of lower EGA (p=0.03), lower birth weight (p=0.01), more often of multiple gestation (p=0.03), more frequently born emergently (p=0.03), had a greater number of ventilator days (p=0.03), received postnatal steroids more often (p=0.02), had a greater incidence of hemodynamically significant PDA, and less frequently had pulmonary hemorrhage (p=0.04) In multinomial regression analysis, three factors were identified which favored cerebellar hemorrhage over IVH: multiple gestation (RR 4.70, 95% CI 1.56–14.21, p<0.01), chorioamnionitis (RR 3.18, 95% CI 1.13–8.92, p=0.03), and emergent delivery (RR 4.14, 95% CI 1.48–11.55, p<0.01). Only advancing gestational favored IVH over cerebellar hemorrhage (RR 0.74, 95% CI 0.65–0.85, p<0.01). CONCLUSIONS: IVH and CH have unique risk factors. These results highlight the need to tailor neuroimaging surveillance to specific patient risk factors.