Intraventricular Hemorrhage in Premature Infants and Its Association with Pneumothorax

  • Narjes Pishva Neonatology Research Center, Namazi Hospital, Shiraz University of Medical Science, Shiraz, Iran.
  • Gholamreza Parsa Neonatology Research Center, Namazi Hospital, Shiraz University of Medical Science, Shiraz, Iran.
  • Forough Saki Mail Department of Pediatrics, Namazi Hospital, Shiraz University of Medical Science, Shiraz, Iran.
  • Mohammad Reza Saki Department of Medicine, Shiraz University of Medical Science, Shiraz, Iran.
Pneumothorax, Intraventricular hemorrhage, Neonates


Intraventricular hemorrhage (IVH) is one of the major causes of the cerebral palsy and mental retardation. Prevention and early management of these neurologic developmental problems will require determining the perinatal risk factors associated with this clinical entity. Pneumothorax increase the risk of IVH, and cause of pneumothorax has an important effect in severity of IVH. This is a prospective cross sectional study in 2010. This study includes 150 preterm neonates. Cranial ultrasound was performed in all neonates in age 3, 7, 30, 60, just after pneumothorax and every 2 week until chest tube discontinuation. Then prevalence of IVH and pneumothorax was calculated in preterm infant and severity of IVH was investigated before and after development of pneumothorax, and this comparison was divided by different causes of pneumothorax with SPSS version 11.5. Prevalence of IVH and pneumothorax in preterm infants were 30% and 10% respectively. Pneumothorax was not a risk factor of IVH (P>0.05), but prevalence of pneumothorax caused by RDS was a risk factor of development of IVH (P=0.01). Also pneumothorax in patients with birth weight less than 1000 g and gestational age less than 28 week was a risk factor of IVH pneumothorax (P=0.008, P=0.01 respectively). Our study discusses the differences in previous studies about association of pneumothorax and IVH. Also we suggest the hypothesis that lack of cerebral autoregulation in neonates with gestational age less than 28 week can cause IVH development after hypotension induces by pneumothorax.


Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR, Bauer CR, Donovan EF, Korones SB, Laptook AR, Lemons JA, Oh W, Papile LA, Shankaran S, Stevenson DK, et al; NICHD Neonatal Research Network. Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol 2007;196(2):147.e1-8.

Kusuda S, Fujimura M, Sakuma I, Aotani H, Kabe K, Itani Y, Ichiba H, Matsunami K, Nishida H; Neonatal Research Network, Japan. Morbidity and mortality of infants with very low birth weight in Japan: center variation. Pediatrics 2006;118(4):e1130-8.

Heuchan AM, Evans N, Henderson Smart DJ, Simpson JM. Perinatal risk factors for major intraventricular haemorrhage in the Australian and New Zealand Neonatal Network, 1995-97. Arch Dis Child Fetal Neonatal Ed 2002;86(2):F86-90.

Synnes AR, Chien LY, Peliowski A, Baboolal R, Lee SK; Canadian NICU Network. Variations in intraventricular hemorrhage incidence rates among Canadian neonatal intensive care units. J Pediatr 2001;138(4):525-31.

Osborn DA, Evans N, Kluckow M. Hemodynamic and antecedent risk factors of early and late periventricular/intraventricular hemorrhage in premature infants. Pediatrics 2003;112(1 Pt 1):33-9.

Babnik J, Stucin-Gantar I, Kornhauser-Cerar L, Sinkovec J, Wraber B, Derganc M. Intrauterine inflammation and the onset of peri-intraventricular hemorrhage in premature infants. Biol Neonate 2006;90(2):113-21.

Vural M, Yilmaz I, Ilikkan B, Erginoz E, Perk Y. Intraventricular hemorrhage in preterm newborns: riskmfactors and results from a University Hospital in Istanbul, 8 years after. Pediatr Int 2007;49(3):341-4.

Hall RT, Rhodes PG. Pneumothorax and pneumomediastinum in infants with idiopathic respiratory distress syndrome receiving continuous positive airway pressure. Pediatrics 1975;55(4):493-6.

Ogata ES, Gregory GA, Kitterman JA, Phibbs RH, Tooley WH. Pneumothorax in the respiratory distress syndrome: incidence and effect on vital signs, blood gases, and pH. Pediatrics 1976;58(2):177-83.

Mehrabani D, Gowen CW Jr, Kopelman AE. Associationof pneumothorax and hypotension with intraventricular haemorrhage. Arch Dis Child 1991;66(1 Spec No):48-51.

Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978;92(4):529-34.

Lipscomb AP, Thorburn RJ, Reynolds EO, Stewart AL, Blackwell RJ, Cusick G, Whitehead MD. Pneumothorax and cerebral haemorrhage in preterm infants. Lancet 1981;1(8217):414-6.

Dykes FD, Lazzara A, Ahmann P, Blumenstein B, Schwartz J, Brann AW. Intraventricular hemorrhage: aprospective evaluation of etiopathogenesis. Pediatrics 1980;66(1):42-9.

Hill A, Perlman JM, Volpe JJ. Relationship of pneumothorax to occurrence of intraventricular hemorrhage in the premature newborn. Pediatrics 1982;69(2):144-9.

Cooke RW. Factors associated with periventricular haemorrhage in very low birthweight infants. Arch Dis Child 1981;56(6):425-31.

Van de Bor M, Van Bel F, Lineman R, Ruys JH. Perinatal factors and periventricular-intraventricular hemorrhage in preterm infants. Am J Dis Child 1986;140(11):1125-30.

Volpe JJ. Neurology of the Newborn. 2nd ed. Philadelphia, PA: WB Saunders; 1987.

Lou HC. The "lost autoregulation hypothesis" and brain lesions in the newborn: an update. Brain Dev. 1988;10(3):143-6.

Sarkar S, Bhagat I, Dechert R, Schumacher RE, Donn SM.Severe intraventricular hemorrhage in preterm infants: comparison of risk factors and short-term neonatal morbidities between grade 3 and grade 4 intraventricularhemorrhage. Am J Perinatol. 2009;26(6):419-24.

How to Cite
Pishva N, Parsa G, Saki F, Saki MR. Intraventricular Hemorrhage in Premature Infants and Its Association with Pneumothorax. Acta Med Iran. 50(7):473-476.