The prevalence of intraventricular hemorrhage and its related risk factors among preterm neonates

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AlGhamdi" }, { "@type": "Person", "name": "Abdulrahman A. Alnaim" }, { "@type": "Person", "name": "Hussain A AlGhadeer" }, { "@type": "Person", "name": "Alaa A. Aldajani" }, { "@type": "Person", "name": "Muneera A. Alabdulqader" }, { "@type": "Person", "name": "Abdullah A. Alarbash" }, { "@type": "Person", "name": "Abdullah S. Alkhamis" }, { "@type": "Person", "name": "Layan Y. AlBassam" }, { "@type": "Person", "name": "Fai A. AlQahtani" }, { "@type": "Person", "name": "Dina W. Abdulghani" }, { "@type": "Person", "name": "Khalid Al Noaim" }, { "@type": "Person", "name": "Abdulaziz A. Alahmari" }, { "@type": "Person", "name": "Muntather S. Alhejji" }, { "@type": "Person", "name": "Eman F. Alamer" }, { "@type": "Person", "name": "Hawra M. Aldandan" }, { "@type": "Person", "name": "Sameer S. Al Ostaz" }, { "@type": "Person", "name": "Anas M. Alharbi" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": " Introduction Intraventricular hemorrhage (IVH) is a serious concern for preterm infants and can predispose such infants to brain injury and poor neurodevelopmental outcomes. Aim The present study aimed to determine the frequency of IVH and its risk factors in the premature newborns admitted to the Neonatal Intensive Care Unit (NICU) at King Fahd University Hospital. Methodology This cross-sectional study involved 201 preterm neonates admitted at King Fahd University Hospital, Khobar, Saudi Arabia over a period of 7 years (from 2016 to 2023). These neonates were diagnosed by cranial ultrasound. IVH was classified into four grades based on Papile classification. The frequency of IVH was compared across various attributing factors i.e., gestational age at delivery, gender, birth weight, mode of delivery, and maternal antenatal steroids. Results Two hundred and one patients were analyzed (male 50.7% vs. female 49.3%). 51.2% had a gestational age of 29 weeks or less. More than half (54.2%) had a birth weight of ≤1200g. The incidence of IVH in a 7-year duration was 41.8%, with stage 1 (41.7%) and stage 2 (34.5%) being the most common IVH stages. Multivariate regression analysis revealed that CHD, seizure, and ROP were identified as the significant independent predictors of IVH among preterm infants. Conclusion IVH in premature infants remains a complex and delicate issue in neonatology. An integrated approach covering both prevention and treatment is essential to minimize the negative impact of this complication on the neurological development of premature infants. 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F1000Research 2025, 14 :562 ( https://doi.org/10.12688/f1000research.163866.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article The prevalence of intraventricular hemorrhage and its related risk factors among preterm neonates [version 1; peer review: awaiting peer review] Mohammad A. AlGhamdi https://orcid.org/0009-0004-3946-2226 1 , Abdulrahman A. Alnaim 2 , Hussain A AlGhadeer https://orcid.org/0009-0002-9128-8005 3 , [...] Alaa A. Aldajani 4 , Muneera A. Alabdulqader 2 , Abdullah A. Alarbash 3 , Abdullah S. Alkhamis 3 , Layan Y. AlBassam 4 , Fai A. AlQahtani 4 , Dina W. Abdulghani https://orcid.org/0009-0000-3202-9826 1 , Khalid Al Noaim https://orcid.org/0000-0001-5469-1220 2 , Abdulaziz A. Alahmari https://orcid.org/0000-0003-2706-324X 4 , Muntather S. Alhejji 5 , Eman F. Alamer 6 , Hawra M. Aldandan 2 , Sameer S. Al Ostaz 2 , Anas M. Alharbi 2 Mohammad A. AlGhamdi https://orcid.org/0009-0004-3946-2226 1 , Abdulrahman A. Alnaim 2 , [...] Hussain A AlGhadeer https://orcid.org/0009-0002-9128-8005 3 , Alaa A. Aldajani 4 , Muneera A. Alabdulqader 2 , Abdullah A. Alarbash 3 , Abdullah S. Alkhamis 3 , Layan Y. AlBassam 4 , Fai A. AlQahtani 4 , Dina W. Abdulghani https://orcid.org/0009-0000-3202-9826 1 , Khalid Al Noaim https://orcid.org/0000-0001-5469-1220 2 , Abdulaziz A. Alahmari https://orcid.org/0000-0003-2706-324X 4 , Muntather S. Alhejji 5 , Eman F. Alamer 6 , Hawra M. Aldandan 2 , Sameer S. Al Ostaz 2 , Anas M. Alharbi 2 PUBLISHED 06 Jun 2025 Author details Author details 1 Department of Neonatology, Collage of medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Alkhobar, Saudi Arabia 2 Department of Pediatrics, College of Medicine, King Faisal University,, AlAhsa, Saudi Arabia 3 Department of Pediatrics, Maternity and Children Hospital, AlAhsa, Saudi Arabia 4 Department of Pediatrics, College of Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Alkhobar, Saudi Arabia 5 Department of Pediatrics, Maternity and Children Hospital, Dammam, Saudi Arabia 6 Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia Mohammad A. AlGhamdi Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Software, Validation, Visualization, Writing – Review & Editing Abdulrahman A. Alnaim Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Hussain A AlGhadeer Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software Alaa A. Aldajani Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Resources, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Muneera A. Alabdulqader Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Validation, Writing – Original Draft Preparation Abdullah A. Alarbash Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Software, Supervision, Visualization, Writing – Review & Editing Abdullah S. Alkhamis Roles: Conceptualization, Data Curation, Investigation, Project Administration, Resources, Supervision, Visualization, Writing – Original Draft Preparation Layan Y. AlBassam Roles: Conceptualization, Formal Analysis, Funding Acquisition, Project Administration, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Fai A. AlQahtani Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Project Administration, Resources, Software, Validation, Writing – Review & Editing Dina W. Abdulghani Roles: Conceptualization, Formal Analysis, Investigation, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Khalid Al Noaim Roles: Conceptualization, Investigation, Methodology, Project Administration, Resources, Software, Visualization, Writing – Review & Editing Abdulaziz A. Alahmari Roles: Conceptualization, Formal Analysis, Investigation, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Muntather S. Alhejji Roles: Conceptualization, Data Curation, Funding Acquisition, Methodology, Resources, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Eman F. Alamer Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Validation, Writing – Review & Editing Hawra M. Aldandan Roles: Writing – Review & Editing Sameer S. Al Ostaz Roles: Conceptualization, Data Curation, Project Administration Anas M. Alharbi Roles: Conceptualization, Data Curation, Project Administration OPEN PEER REVIEW REVIEWER STATUS AWAITING PEER REVIEW Abstract Introduction Intraventricular hemorrhage (IVH) is a serious concern for preterm infants and can predispose such infants to brain injury and poor neurodevelopmental outcomes. Aim The present study aimed to determine the frequency of IVH and its risk factors in the premature newborns admitted to the Neonatal Intensive Care Unit (NICU) at King Fahd University Hospital. Methodology This cross-sectional study involved 201 preterm neonates admitted at King Fahd University Hospital, Khobar, Saudi Arabia over a period of 7 years (from 2016 to 2023). These neonates were diagnosed by cranial ultrasound. IVH was classified into four grades based on Papile classification. The frequency of IVH was compared across various attributing factors i.e., gestational age at delivery, gender, birth weight, mode of delivery, and maternal antenatal steroids. Results Two hundred and one patients were analyzed (male 50.7% vs. female 49.3%). 51.2% had a gestational age of 29 weeks or less. More than half (54.2%) had a birth weight of ≤1200g. The incidence of IVH in a 7-year duration was 41.8%, with stage 1 (41.7%) and stage 2 (34.5%) being the most common IVH stages. Multivariate regression analysis revealed that CHD, seizure, and ROP were identified as the significant independent predictors of IVH among preterm infants. Conclusion IVH in premature infants remains a complex and delicate issue in neonatology. An integrated approach covering both prevention and treatment is essential to minimize the negative impact of this complication on the neurological development of premature infants. READ ALL READ LESS Keywords Intraventricular hemorrhage, prematurity, low birth weight, cranial ultrasound, Saudi Arabia Corresponding Author(s) Abdulrahman A. Alnaim ( [email protected] ) Close Corresponding author: Abdulrahman A. Alnaim Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 AlGhamdi MA et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: AlGhamdi MA, Alnaim AA, AlGhadeer HA et al. The prevalence of intraventricular hemorrhage and its related risk factors among preterm neonates [version 1; peer review: awaiting peer review] . F1000Research 2025, 14 :562 ( https://doi.org/10.12688/f1000research.163866.1 ) First published: 06 Jun 2025, 14 :562 ( https://doi.org/10.12688/f1000research.163866.1 ) Latest published: 06 Jun 2025, 14 :562 ( https://doi.org/10.12688/f1000research.163866.1 ) Introduction Regardless of gestational age, low birth weight infants are born weighing less than 2.5 kg, and preterm infants are born at less than 37 weeks gestational age. For newborns and children under five, preterm birth is the primary cause of mortality and morbidity. 1 The survival rate of preterm infants has increased dramatically in the last 20 years due to advancements in neonatal perinatal services. This progress is a result of increased prenatal steroid use, surfactant therapy, better respiratory and nutritional management, and other advancements in prenatal, perinatal, and neonatal care. 2 The high morbidities of these preterm infants, which are linked to a higher incidence of adverse neurodevelopmental outcomes, continue to be a serious concern despite this improvement. Intraventricular hemorrhage (IVH) is one of the main morbidities that seriously impairs mental retardation, cerebral palsy, and immediate mortality. 2 In preterm infants, the overall incidence of IVH is approximately 36%, and the incidence rises with decreasing gestational age and birth weight. 3 , 4 It affects roughly 52% of preterm infants born at less than 28 weeks’ gestation and 45% of extremely preterm infants weighing less than 750 g at birth. 4 , 5 Ninety percent of IVH cases happen within three days of birth, and fifty percent happen within one day following birth. 4 , 6 The Papile system divides IVH into four grades, which is helpful in assessing the phenomenon and predicting the outcome during the neonatal period as well as during the follow-up period. 7 The following are known risk factors for IVH: birth weight, asphyxia, hypoxia, infection, coagulation dysfunction, twins, intrauterine infection, mechanical ventilation, respiratory distress syndrome requiring surfactant treatment, placenta abnormalities such as placenta abruption. 8 The overall mortality risk was comparable for infants with (4–7%) and without (10%) IVH of grade one, and it was significantly higher for infants with higher IVH values, specifically 8–10% for grade two, 18% for grade three, and approximately 40% for grade four. 9 , 10 The survival rate of extremely preterm infants has increased due to advancements in neonatal intensive care, which has consequently increased the number of infants at high risk of developing IVH. 11 In order to determine the prevalence, related risk factors, and short-term consequences of intraventricular hemorrhage (IVH) among preterm neonates at King Fahd University Hospital in Khobar, Saudi Arabia, this study was conducted. Methods Aim of the study To determine the prevalence, associated risk factors and short-term outcomes of intraventricular haemorrhage (IVH) among preterm neonates in King Fahd University Hospital, Khobar, Saudi Arabia. Rational and importance The assessment of disease burden, the distribution of public health resources, and the goals of clinical research may all benefit from a understand the existing of the emerging epidemiological data of comorbidities among preterm infants. Study design and population This retrospective study included 201 preterm infants who were diagnosed with IVH by cranial ultrasonography and were born at or before 37 weeks of gestational age (GA) between 2016 and 2023 at King Fahd University Hospital in Khobar, Saudi Arabia. After 72 to 96 hours of life, and then every week until discharge, newborns with a gestational age of less than 34 weeks and a birth weight of less than 1500 g were screened using cranial ultrasonography. Inclusion criteria • Age 28 days old • Birth weight > 1500 g • Gestational age > 34 weeks • Outborn neonates • Genetic syndromes • Congenital malformation • Died before cranial ultrasound examination Data collection The diagnosis and classification of IVH were based on those of Papile 7 : Grade I: Germinal matrix hemorrhage. Grade II: As intraventricular hemorrhage without ventricular dilatation. Grade III: Intraventricular hemorrhage filling more than 50% of the ventricle and with ventricular dilatation. Grade IV: Intraparenchymal hemorrhage. Neonatal characteristics (gestational age, birth weight, gender, 5-min Apgar score, mode of delivery) and maternal characteristics (pregnancy hypertension, placental abruption, gestational diabetes, abnormal amniotic fluid, fetal distress, premature rupture of membranes) as well as neonatal complications (respiratory distress syndrome (RDS), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), periventricular leukomalacia (PVL), sepsis, and severe anemia) were considered to have a potential impact on IVH in preterm infants. Data analysis Descriptive statistics were presented using numbers and percentages for all categorical variables. Univariate analysis was performed to determine the factors that influence IVH. Significant results were then tested in a multivariate regression analysis to determine the significant independent predictors associated with IVH in preterm infants, with corresponding odd ratios and 95% confidence intervals. Statistical significance was set to p<0.05 level. All data analyses were performed using Statistical Packages for Social Sciences (SPSS) version 26 Armonk, NY: IBM Corporation. Ethics Investigators will access the patients’ information from their medical records, by a permission obtained from the hospital administration. Informed consent was not required since the study will be retrospective and performed by a chart review without any potential risk implicated upon the patients. Confidentiality, deidentification, and anonymity of personal data will be strictly maintained all throughout. Results This study reviewed two hundred and one preterm infants. As described in ( Table 1 ), 50.7% were males. Regarding maternal characteristics, 51.2% had a gestational age of 29 weeks or less. The most common method of delivery was caesarean (63.2%). Half of the mothers had a maternal age of over 30 years. Birth patterns were mostly singleton (77.6%). Table 1. Biographical data maternal and neonatal (n=201) . Study variables Number (%) Gender • Male 102 (50.7%) • Female 99 (49.3%) Gestational age • ≤29 weeks 103 (51.2%) • >29 weeks 98 (48.8%) Birth weight • ≤1200 gram 109 (54.2%) • >1200 gram 92 (45.8%) Mode of delivery • Caesarean section 127 (63.2%) • Normal vaginal delivery 74 (36.8%) Maternal age • ≤30 years 100 (49.8%) • >30 years 101 (50.2%) Birth pattern • Single 156 (77.6%) • Twin 32 (15.9%) • Triplet 13 (06.5%) Follow-up • No 139 (69.2%) • Yes 62 (30.8%) Multiple birth • No 100 (48.8%) • Yes 101 (50.2%) ( Table 2 ) shows the medical characteristics of the comorbidities of the patients. About 87.1% were diagnosed with septicemia, and 14.9% had NEC. The incidence of IVH was 41.8%, with grade 1 being the most common reported (41.7%). BPD, CHD, hydrocephalus, RDS, seizure, PRBC, IUGR, jaundice, and PROM were seen in 16.9%, 38.3%, 3.5%, 88.1%, 6.5%, 48.3%, 14.9%, 62.7%, and 15.4%, respectively. ROP was 37.3%, with stage 1 being the most frequent (45.3%). DM, PIH, pre-eclampsia, hypothyroidism, IVF, chorioamnionitis, consanguinity, UTI, pneumothorax, pulmonary hemorrhage, and pulmonary hypertension were seen in 9.5%, 11.4%, 12.9%, 2%, 14.4%, 3%, 49.8%, 33.3%, 3%, 4.5%, and 6.5%, respectively. Regarding patient treatment and management, nearly all (95.5%) received antenatal steroids, while 7% received steroids during the postnatal period (7%). Surfactants were administered to 60.7% of the patients of them, 41.8% received a single dose. In addition, nearly half (44.3%) used oxygen for more than 28 days. Table 2. Medical characteristics and comorbidities (n=201) . Variables N (%) Septicaemia 175 (87.1%) Necrotizing enterocolitis (NEC) 30 (14.9%) Intraventricular haemorrhage (IVH) 84 (41.8%) IVH level (n=84) • Grade 1 35 (41.7%) • Grade 2 29 (34.5%) • Grade 3 12 (14.3%) • Grade 4 05 (06.0%) • Not specified 03 (03.6%) Bronchopulmonary dysplasia (BPD) 34 (16.9%) Congenital heart disease (CHD) 77 (38.3%) Hydrocephalus 07 (03.5%) Respiratory Distress Syndrome (RDS) 177 (88.1%) Seizure 13 (06.5%) Packed red blood cells (PRBC) transfusion 97 (48.3%) Intrauterine growth restriction (IUGR) 30 (14.9%) Jaundice 126 (62.7%) Retinopathy of prematurity (ROP) 75 (37.3%) ROP stage • Stage 0 01 (01.3%) • Stage 1 34 (45.3%) • Stage 2 24 (32.0%) • Stage 3 16 (21.3%) Premature rupture of membranes (PROM) 31 (15.4%) Diabetes mellitus (DM) 19 (09.5%) Pregnancy-induced hypertension (PIH) 23 (11.4%) Pre-eclampsia 26 (12.9%) Hypothyroidism 04 (02.0%) In vitro fertilization 29 (14.4%) Chorioamnionitis 06 (03.0%) Consanguinity 100 (49.8%) Urinary Tract Infection 67 (33.3%) Pneumothorax 06 (03.0%) Pulmonary hemorrhage 09 (04.5%) Pulmonary hypertension 13 (06.5%) Management Antenatal steroid • No 09 (04.5%) • Yes 192 (95.5%) Postnatal steroid • No 187 (93.0%) • Yes 14 (07.0%) Surfactant • No 79 (39.3%) • Yes 122 (60.7%) Surfactant dose (n=122) • 1 dose 51 (41.8%) • 2 doses 29 (23.8%) • 3 doses 05 (04.1%) • Not specified 37 (30.3%) O2 duration • 28 days 89 (44.3%) In ( Table 3 ) the incidence of IVH was significantly more common among patients with a birth weight of 1200 g or less (p=0.001), those who were born by NVD method (p=0.007), increasing duration of oxygen used (p<0.001), septicemia (p=0.003), CHD (p<0.001), RDS (p=0.002), seizure (p=0.008), PRBC (p<0.001), jaundice (p<0.001), ROP (p<0.001), and consanguinity (p<0.001). Table 3. Univariate analysis for the predictors of IVH in preterm infants (n=201) . Factor IVH P-value § Yes N (%) (n=84) No N (%) (n=117) Gender • Male 44 (52.4%) 58 (49.6%) 0.694 • Female 40 (47.6%) 59 (50.4%) Gestational age • ≤29 weeks 49 (58.3%) 54 (46.2%) 0.088 • >29 weeks 35 (41.7%) 63 (53.8%) Birth weight • ≤1200 g 57 (67.9%) 52 (44.4%) 0.001 ** • >1200 g 27 (32.1%) 65 (55.6%) Mode of delivery • Caesarean section 44 (52.4%) 83 (70.9%) 0.007 ** • Normal vaginal delivery 40 (47.6%) 34 (29.1%) Maternal age • ≤30 years 37 (44.0%) 64 (54.7%) 0.136 • >30 years 47 (56.0%) 53 (45.3%) Birth • No 40 (47.6%) 57 (48.7%) 0.878 • Yes 44 (52.4%) 60 (51.3%) Multiple birth • No 43 (51.2%) 57 (48.7%) 0.730 • Yes 41 (48.8%) 60 (51.3%) Birth pattern • Single 64 (76.2%) 92 (78.6%) 0.455 • Twin 16 (19.0%) 16 (13.7%) • Triplet 04 (04.8%) 09 (07.7%) O2 duration • <28 days 30 (35.7%) 82 (70.1%) 28 days 54 (64.3%) 35 (29.9%) Follow-up 38 (45.2%) 24 (20.5%) <0.001 ** Antenatal steroid 78 (92.9%) 114 (97.4%) 0.122 Postnatal steroid 07 (08.3%) 07 (06.0%) 0.519 Surfactant 65 (77.4%) 57 (48.7%) <0.001 ** Septicemia 80 (95.2%) 95 (81.2%) 0.003 ** Necrotizing enterocolitis (NEC) 13 (15.5%) 17 (14.5%) 0.853 Bronchopulmonary dysplasia (BPD) 18 (21.4%) 16 (13.7%) 0.148 Congenital heart disease (CHD) 52 (61.9%) 25 (21.4%) <0.001 ** Respiratory Distress Syndrome (RDS) 81 (96.4%) 96 (82.1%) 0.002 ** Seizure 10 (11.9%) 03 (02.6%) 0.008 ** Packed red blood cells (PRBC) transfusion 54 (64.3%) 43 (36.8%) <0.001 ** Intrauterine growth restriction (IUGR) 12 (14.3%) 18 (15.4%) 0.829 Jaundice 67 (79.8%) 59 (50.4%) <0.001 ** Retinopathy of prematurity (ROP) 49 (58.3%) 26 (22.2%) <0.001 ** Premature rupture of membranes (PROM) 12 (14.3%) 19 (16.2%) 0.705 Diabetes mellitus (DM) 08 (09.5%) 11 (09.4%) 0.977 Pregnancy-induced hypertension (PIH) 10 (11.9%) 13 (11.1%) 0.862 Pre-eclampsia 13 (15.5%) 13 (11.1%) 0.363 In vitro fertilization 10 (11.9%) 19 (16.2%) 0.388 Consanguinity 55 (65.5%) 45 (38.5%) <0.001 ** Urinary Tract Infection 33 (39.3%) 34 (29.1%) 0.129 § P-value has been calculated using Chi-square test. ** Significant at p<0.05 level. A multivariate regression analysis was subsequently performed in ( Table 4 ) to determine the significant independent predictors of IVH. Based on the results, it was found that patients with CHD were predicted to increase the risk of having IVH by at least 4.27 times higher (AOR=4.272; 95% CI=1.987 – 9.183; p<0.001). Patients with seizures were at increased risk of having IVH by almost 5.5 times higher (AOR=5.496; 95% CI=1.208 – 24.996; p=0.027). Also, patients who had ROP were at increased risk of having IVH by at least 3.2-fold higher (AOR=3.158; 95% CI = 1.057 – 9.349; p=0.039). No significant effects were observed between the incidence of IVH in relation to birth weight, mode of delivery, O2 duration, follow-up, surfactant used, septicemia, RDS, PRBC, jaundice, and consanguinity after adjustment to a regression model (p>0.05). Table 4. Multivariate regression analysis to determine significant independent predictors of IVH in preterm infants (n=201) . Factor AOR 95% CI P-value Birth weight • ≤1200 g Ref • >1200 g 0.980 0.428 – 2.243 0.962 Mode of delivery • CS Ref • NVD 1.994 0.980 – 4.059 0.057 O2 duration • 28 days 1.195 0.468 – 3.051 0.710 Follow-up • No Ref • Yes 0.808 0.284 – 2.304 0.690 Surfactant • No Ref • Yes 1.129 0.433 – 2.939 0.804 Septicemia • No Ref • Yes 0.994 0.224 – 4.400 0.993 Congenital heart disease (CHD) • No Ref • Yes 4.272 1.987 – 9.183 <0.001 ** Respiratory Distress Syndrome (RDS) • No Ref • Yes 1.921 0.369 – 9.998 0.438 Seizure • No Ref • Yes 5.496 1.208 – 24.996 0.027 ** Packed red blood cells (PRBC) transfusion • No Ref • Yes 0.596 0.226 – 1.575 0.297 Jaundice • No Ref • Yes 1.886 0.839 – 4.239 0.125 Retinopathy of prematurity (ROP) • No Ref • Yes 3.158 1.057 – 9.439 0.039 ** Consanguinity • No Ref • Yes 1.232 0.536 – 2.830 0.623 ** Significant at p<0.05 level. Discussion This study explores the incidence of IVH among preterm infants born between 01 January 2016 and 01 January 2023 at King Fahad Hospital of The University, Khobar, Saudi Arabia. The results showed that among the 207 preterm infants collected, 84 of them had IVH, and the overall incidence was 41.8%. IVH grade mainly was mild (grade 1 + grade 2: 76.2%), and only 20.3% were classified as severe (grade 3 + grade 4). This is strikingly similar to that of Maduray et al. (2019). 12 Study documented an IVH prevalence of 67% and 44.3% detected among VLBW and LBW infants. Consistent with these reports, Sisenda et al. (2022) 13 indicated that the one-year prevalence of IVH among preterm neonates was 33.8%, mainly mild (67.6%) followed by severe (32.4%). According to the systematic review of Siffel et al. (2021), 14 the worldwide incidence of IVH grade 3/4 ranges between 5% and 52%. Considering population-based studies, the rate of IVH grade 3/4 was between 6% and 22%. Lower IVH grades, however, were rarely documented, but they evolved between 5% and 19%. Based on our univariate analysis, low birth weight is a predictor of IVH among preterm infants; however, this did not remain significant in a multivariate regression model (p=0.972). Further, we found a higher prevalence of IVH among those who were born through NVD, have over 28 days of O2 use, those who have required follow-ups, and those with septicemia, NEC, RDS, PRBC, jaundice, PROM, and consanguinity. However, we did not find an association between IVH in terms of gender, maternal age, multiple births, birth patterns, and gestational age (p>0.05). This contradicted the reports of a study done in South Africa, suggesting that birth weight and gestational were significantly associated with IVH. 13 In Nigeria, lower gestational age (<32 weeks gestation), low Apgar scores, need for respiratory support, lower social class, outborn status of neonates, and blood transfusion were recognized as predictors of IVH. 15 Consistent with these reports, a study published in Canada also recognized weight and small birth gestation as risk factors for IVH. Other important predictors identified in the study were insufficiency of antenatal corticosteroids, chorioamnionitis, Apgar score, RDS, prolonged intubation, early-onset sepsis, hypercapnia, pCO2 fluctuations, inhaled nitric oxide, inotropes or normal saline boluses, bicarbonate/THAM therapy opioids infusions, and metabolic derangements. 16 In our multivariate regression estimates, only CHD, seizure, and ROP remained significant and were determined to be the independent risk factors for IVH. In Portugal, multivariate regression estimates that the significant risk factors for Germinal Matrix Hemorrhage (GMH)-IVH include resuscitation exposure in the delivery room, visual impairment, and gross motor and locomotor dysfunction. 17 In Poland, multivariate analysis suggested that the more risk factors present, the greater the risk of severe IVH degrees, particularly in children born before 32 weeks of gestation and without AST and born with asphyxia and hypotension and with acidosis. In addition, grade 3 and 4 IVH were linked to increased mortality in preterm infants. 12 , 13 , 18 IVH, particularly those severe ones, is a serious condition that develops between the perinatal and postnatal periods. Identifying the occurrence of IVH is a criterion for its antecedents and then applying preventive actions. 19 In our study, antennal steroids were the most prominent treatment being administered to patients. However, steroid use was not identified as a predictive factor for IVH (p=0.122). This did not coincide with the study done in Kenya, 13 suggesting that the use of antennal steroids was associated with decreasing IVH risk. A previous study done in Poland supported these reports. 20 Incomplete or no antenatal steroid therapy could lead to the progression of IVH. Hence, steroid therapy should be considered to be given to women at risk of premature delivery. The implication of IVH magnifies the need to conduct a regional periodical analysis concerning its incidence, causes, and impacts to enhance local treatment outcomes by recognizing courses of action. 20 Limitation We acknowledge that there were limitations to our study. It was observational, so it is difficult to assume causality. Even though we made an effort to control for confounding variables. The second limitation of our study was the follow-up at 18–24 months of corrected age. Further evaluation of the effect of IVH on neurological outcomes in preterm infants requires follow-ups until school age or even longer. Findings from a single-center study with a small number of infants included and a brief follow-up period are additional study limitations. Therefore, it is advised that future multi-center studies with a large patient population use complementary imaging. This information would have further aided in the management planning of these cases. Conclusion There was a high incidence of IVH among preterm infants during the last 7 years. Patients with CHD, seizure, and ROP were the most susceptible to IVH as compared to other preterm infants. Hence, continuous monitoring is vital among these groups of patients, and finding new therapeutic strategies aimed at reducing the serious consequences of IVH is warranted. The factors identified in this study can be considered clinically relevant and subjected to further investigation. Screening and early detection of brain injury among high-risk neonates are crucial to facilitate necessary treatment and management associated with adverse chronic neurodevelopmental outcomes. Ethics and consent This research project was approved by institutional review board of King Fahd Hospital of the University (May 26, 2024) [Certificate# REC-2024-NOV-ETHICS405]. Participants’ information was kept confidential and anonymous. Informed consent was not required since the study will be retrospective. Pre-print citation AlGhamdi M, Alnaim A, Al Ghadeer H, Aldajani A, Alabdulqader M, Alarbash A, Alkhamis A, AlBassam L, AlQahtani F, Abdulghani D, Al Noaim K, Alahmari A, Alhejji M, Alamer E, Aldandan H. The Prevalence Of Intraventricular Hemorrhage And Its Related Risk Factors Among Preterm Neonates. Figshare [Preprint]. 2025 [cited 2025 MAY 6]. Available from: https://doi.org/10.6084/m9.figshare.28731242 . Data availability statement Underlying data Figshare: The Prevalence Of Intraventricular Hemorrhage And Its Related Risk Factors Among Preterm Neonates, https://doi.org/10.6084/m9.figshare.28731242 . 21 This project contains the following underlying data: • Data.xlsx Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). References 1. Behrman RE, Butler AS: Preterm birth: causes, consequences, and prevention. 2. Kadri H, Mawla AA, Kazah J: The incidence, timing, and predisposing factors of germinal matrix and intraventricular hemorrhage (GMH/IVH) in preterm neonates. Childs Nerv. Syst. 2006 Sep; 22 : 1086–1090. PubMed Abstract | Publisher Full Text 3. Chevallier M, Debillon T, Pierrat V, et al. : Leading causes of preterm delivery as risk factors for intraventricular hemorrhage in very preterm infants: results of the EPIPAGE 2 cohort study. Am. J. Obstet. Gynecol. 2017 May 1; 216 (5): 518.e1–518.e12. Publisher Full Text 4. 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Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 06 Jun 2025 ADD YOUR COMMENT Comment Author details Author details 1 Department of Neonatology, Collage of medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Alkhobar, Saudi Arabia 2 Department of Pediatrics, College of Medicine, King Faisal University,, AlAhsa, Saudi Arabia 3 Department of Pediatrics, Maternity and Children Hospital, AlAhsa, Saudi Arabia 4 Department of Pediatrics, College of Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Alkhobar, Saudi Arabia 5 Department of Pediatrics, Maternity and Children Hospital, Dammam, Saudi Arabia 6 Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia Mohammad A. AlGhamdi Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Software, Validation, Visualization, Writing – Review & Editing Abdulrahman A. Alnaim Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Hussain A AlGhadeer Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software Alaa A. Aldajani Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Resources, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Muneera A. Alabdulqader Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Validation, Writing – Original Draft Preparation Abdullah A. Alarbash Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Software, Supervision, Visualization, Writing – Review & Editing Abdullah S. Alkhamis Roles: Conceptualization, Data Curation, Investigation, Project Administration, Resources, Supervision, Visualization, Writing – Original Draft Preparation Layan Y. AlBassam Roles: Conceptualization, Formal Analysis, Funding Acquisition, Project Administration, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Fai A. AlQahtani Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Project Administration, Resources, Software, Validation, Writing – Review & Editing Dina W. Abdulghani Roles: Conceptualization, Formal Analysis, Investigation, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Khalid Al Noaim Roles: Conceptualization, Investigation, Methodology, Project Administration, Resources, Software, Visualization, Writing – Review & Editing Abdulaziz A. Alahmari Roles: Conceptualization, Formal Analysis, Investigation, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Muntather S. Alhejji Roles: Conceptualization, Data Curation, Funding Acquisition, Methodology, Resources, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Eman F. Alamer Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Validation, Writing – Review & Editing Hawra M. Aldandan Roles: Writing – Review & Editing Sameer S. Al Ostaz Roles: Conceptualization, Data Curation, Project Administration Anas M. Alharbi Roles: Conceptualization, Data Curation, Project Administration Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 06 Jun 2025, 14:562 https://doi.org/10.12688/f1000research.163866.1 Copyright © 2025 AlGhamdi MA et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article AlGhamdi MA, Alnaim AA, AlGhadeer HA et al. The prevalence of intraventricular hemorrhage and its related risk factors among preterm neonates [version 1; peer review: awaiting peer review] . 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