Resident Physician Baylor Scott and White Health Temple, TX, US
Introduction: Germinal matrix hemorrhage/intraventricular hemorrhage (GMH-IVH) affects primarily preterm infants and causes significant morbidity and mortality. Health disparities are a reality for underserved populations, such as those rural patients. As our institution serves a substantial portion of rural patients, we examined mortality rates and rates of permanent cerebrospinal fluid (CSF) diversion in newborns with GMH-IVH.
Methods: In this retrospective cohort study of patients with GMH-IVH admitted to our neonatal intensive care unit in 2014-2019, the primary outcomes were rates of mortality and permanent CSF diversion. We examined if demographic, socioeconomic, and disease-specific factors were associated with these outcomes. Rurality was analyzed using two different Rural-Urban Commuting Area Codes based upon Zone Improvement Program codes.
Results: A total of 162 patients met study criteria, of which 26 (15.6%) did not survive hospitalization. Survival was associated with older gestational age at birth as quantified by a modified World Health Organization prematurity subcategory (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.1–4.6, p=.04) and permanent CSF diversion (OR 11.1, 95% CI 1.6–229.5, p=.04). Survival was negatively associated with higher grade GMH-IVH (OR 0.45, 95% CI 0.28–0.70, p<.001) and bilateral GMH-IVH (OR 0.34, 95% CI 0.11–0.92, p=.04). Permanent CSF diversion was associated with higher grade GMH-IVH (OR 7.4, 95% CI 3.0–29.6, p<.001). Rurality did not meet univariable screening criteria for logistic regression and was considered non-significant.
Conclusion : Our mortality and shunt rates mirrored published rates, and rurality was not associated with increased mortality or hydrocephalus. However, further research with differing definitions of rurality and more patients may reveal healthcare disparities for which actionable interventions can be designed.
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