Impact of Early-Onset Sepsis on the Development and Severity of Intraventricular Hemorrhage in Premature Neonates: A Retrospective Single-Center Study.

OBJECTIVE

Intraventricular hemorrhage (IVH) is a major cause of morbidity and mortality in premature infants. Early onset neonatal sepsis (EOS) may increase the risk and severity of IVH through inflammation and hemodynamic instability. This study evaluated the association between sepsis and IVH severity.

METHODS

This retrospective, single-center study included neonates diagnosed with IVH and followed in the Neonatal Intensive Care Unit of a tertiary hospital between January 2021 and December 2022. IVH grading was based on Papile's classification, and patients were categorized as low-grade (Grades I-II) or high-grade (Grade III IVH and periventricular hemorrhagic infarction [PVHI], previously referred to as Grade IV IVH). Clinical and laboratory data, including cerebrospinal fluid (CSF) and blood culture results, were analyzed. Logistic regression was used to identify factors associated with high-grade IVH.

RESULTS

A total of 61 neonates were included, of whom 49 (80.3%) had high-grade IVH. Sepsis was detected in 33 of 49 patients (67.3%) with high-grade IVH, representing a statistically significant difference compared with the low-grade group (p = 0.047). Logistic regression analysis identified sepsis as an independent predictor of high-grade IVH, increasing the likelihood approximately fourfold. All patients with positive CSF cultures were in the high-grade IVH group, and CSF glucose levels were significantly lower (p < 0.05), suggesting central nervous system infection or inflammation.

CONCLUSIONS

Sepsis significantly increases the risk of severe (high-grade) intraventricular hemorrhage in premature infants. Early diagnosis and prompt treatment of neonatal sepsis and meningitis are crucial for preventing infection-related brain injury and improving neurodevelopmental outcomes.