Initial hematocrit values after birth and peri/intraventricular hemorrhage in extremely low birth weight infants

Objectiveischemia followed by reperfusion plays a significant role in the pathogenesis of peri/intraventricular hemorrhage (p/ivh). delayed cord clamping promotes placental transfusion to newborn and is associated with decreased p/ivh. we hypothesized that extremely low birth weight (elbw) infants with higher initial hematocrit (hct) after birth are less likely to develop p/ivh.study designpre- and postnatal data on inborn elbw infants over 7 years were reviewed. we examined the relationship between p/ivh in the first week and initial hct using logistic regression modeling.resultswe studied 225 infants with a median gestational age (ga) 25.7 (22.4–31.7). forty-one percent had grade i–iv p/ivh. in univariate analysis, cesarean section (cs) and higher ga, birth weight, 5-minute apgar, and initial hct were associated with decreased likelihood of p/ivh while higher maximum pco2 in first 3 days and use of inotropes/vasopressors, postnatal steroid for hypotension, hypernatremia, transfusion, and use of insulin for hyperglycemia during the first week of life were associated with increased likelihood of p/ivh. in multiple regression analysis, only ga, cs, and initial hct remained significantly associated with p/ivh. adjusting for ga and cs, the odds of p/ivh was higher with hct < 40% (or 2.04, 95% ci [1.11, 3.76]) and hct < 45% (2.38 [1.19, 4.76]).conclusionhigher initial hct is associated with decreased p/ivh. initial hct < 45% was associated with a 2-fold increase in p/ivh. we speculate that lower initial hct represents a lower intravascular volume status and promotes cerebral hypoperfusion preceding p/ivh.