RESUMO
Introduction: Periventricular leucomalacia (PVL) and intraventricular haemorrhage (IVH) are two most important antecedents of neuro-developmental outcome in very low birth weight infants.Study objective: To determine the incidence of PVL/IVH and it's associated perinatal factors among very low birth weight (VLBW) infants admitted at neonatal unit Muhimbili National Hospital.Material and methods: Prospective study with a nested case-control study was conducted at the neonatal unit from May to November 2000. Three hundred seventy two VLBW neonates were recruited to the study on admission to the neonatal unit and were followed up to the postnatal age of 4 weeks or death depending on which came first. All 372 neonates had initial cranial-ultrasound examination within 72 hours of life. Cranial-ultrasound was done on 179 and 151 neonates at the postnatal age of 2 weeks and 4 weeks respectively. Records of all 372 neonates were reviewed to determine the presence or absence of the various perinatal factors. These data were analysed as a nested case-control study whereby a case was defined as any VLBW who had been recruited in the follow up study and had diagnosis of either PVL or IVH or both by cranial ultrasound and those VLBW who had been recruited in the follow up study without a diagnosis of either PVL or IVH were taken as controls. Results: A total of 4539 neonates were admitted to the neonatal unit during the study period and among these 443 (9.8) were VLBW. Two hundred fifty seven (58) out the 443 VLBW neonates died before the postnatal age of 4 weeks. Among the 372 VLBW infants recruited in the study; PVL was seen in 121/372 (32.5) with an overall incidence rate of 0.125/infant week and IVH was seen in 230/372 (61.8) with an overall incidence rate of 0.247/ infant week. Most of the PVL and IVH occurred during the first 3 days of life. All neonates with grade IV IVH died before the postnatal age of 4 weeks. Forty-seven neonates (12.6) developed post-hemorrhagic hydrocephalus. Maternal hemoglobin and neonatal hemoglobin showed significant `association with PVL and IVH respectively.Conclusion:There is high incidence of VLBW; IVH and PVL. IVH grade IV carries a very high mortality. Routine cranial-ultrasound on all VLBW neonates along with clinical follow up for long-term neuro-developmental outcome is recommended