Prevalence and factors associated with Intracranial Haemorrhage in term Neonates admitted at Kawempe National Referral Hospital

Abstract

Introduction: Intracranial haemorrhage (ICH) is one of the leading causes of neonatal morbidity with devastating long-term outcomes. It is challenging to develop strategies to address intracranial haemorrhage in term neonates’ since there is a dearth of information on the prevalence and risk factors for this condition in our setting. This study aimed to determine the prevalence and factors associated with intracranial haemorrhage in term neonates admitted at the special care unit of Kawempe National Regional Referral, Uganda. Methods: This was a cross-sectional study of term neonates hospitalized in the Special Care Unit of Kawempe National Referral Hospital. Parents of all the neonates who gave consent were interviewed and their babies fully examined to obtain data on socio-demographic factors, antenatal and birth history and new-born clinical features. Blood samples were then drawn for a complete blood count, and a cranial ultrasound scan performed on the 4th day of life to determine the presence, location, type and size/grade of intracranial haemorrhage. Data was entered into EpiData and then exported for analysis with STATA 15.1. Summary statistics were used to describe the socio-demographics, the clinical features, and prevalence while inferential statistics were performed to determine factors associated with ICH. Results: We recruited 296 participants into this study. The mean age of 2 days, mean birth weight of 3.2 Kg and 123 (41.4%) were female. A total 53/296 neonates (17.9%, 95% Confidence Interval (CI): 13.7—22.8) had ICH and most of these was intraventricular haemorrhage (IVH), 51 (96.2%). ICH was associated with not feeding and not receiving parenteral 10% dextrose (Adjusted Odds Ratio (AOR) 2.31, 95% CI (1.20—4.44), p<0.01) and a low platelet count (<140,000) (AOR 2.02, 95% CI (1.02—4.01), p=0.04) but maternal ages 25 - 29 years was protective (AOR 0.28, 95% CI (0.08— 0.99), p= 0.05). Conclusion: Nearly one in five term neonates in Kawempe Referral hospital Special Baby Care Unit has ICH and especially IVH. ICH in these sick neonates is associated probably with periods of dysglycaemia from not feeding and not regularly receiving parenteral doses of dextrose 10% and a low platelet count. Maternal age between 25-29 years is protective. Recommendation All term neonates admitted to the SCU should be screened for intracranial haemorrhage and receive standard glycaemic control during admission.Further research is needed to assess the outcome of neonates with intracranial haemorrhage.