Association Between Early Echocardiography Screening and Intraventricular Hemorrhage in Preterm Infants: A Prospective Observational Multicenter Study

Abstract

Abstract Purpose:To determine whether the application of a protocolized early echocardiographic screening for low systemic blood flow and guided inotropic therapy is associated with reduced intraventricular hemorrhage in preterm infants. Methods: Prospective, observational multicenter study between September 2020 and September 2021 in nine neonatal intensive care units. Preterm infants below 33 weeks of gestational age were eligible. The exposure variable was early targeted neonatal echocardiography screening for low systemic blood flow. Five of the centers performed early screening and guided inotrope therapy (intervention group), and 4 centers did not (control group). Our main outcome was >grade II intraventricular hemorrhage or death within the first 7 days of life. Inverse probability of treatment weighting based on the propensity score accounting for the clustered nature of data was used for the main analysis. Results: 332 preterm infants (131 in the intervention group and 201 in thecontrol group) were included. Protocolized early echocardiography screening for low systemic blood flow and guided inotropic treatment was associated with a significant reduction in > grade II intraventricular hemorrhage or early death (odds ratio 0.285 (95% CI: 0.133-0.611); p=0.001) Conclusions: Early echocardiography screening for low systemic blood flow and guided inotropic treatment may reduce the incidence of intraventricular hemorrhage in preterm infants.