Pooled prevalence and predictors of intraventricular hemorrhage (IVH) in preterm neonates (28-34 weeks) in Africa: a systematic review and meta-analysis.

Objective: To assess the pooled prevalence and predictors of intraventricular hemorrhage (IVH) among preterm neonates born between 28 and 34 weeks of gestational age in Africa.

Methods: A weighted inverse-variance random-effects model estimated the pooled prevalence and predictors of germinal matrix hemorrhage. Heterogeneity was assessed using forest plots and I² statistics, focusing on studies conducted in African settings. Cross-sectional studies published in English between 2004 and 2022 were identified through online and manual searches conducted from September 18 to October 27, 2024. Methods: Intraventricular hemorrhage/Germinal matrix hemorrhage (Grades I-IV), defined as bleeding in a developing brain region that typically resolves by term gestational age.

Results: Ten primary studies involving 2,622 preterm neonates born at 28-34 weeks of gestation were included. The pooled prevalence of IVH was nearly three in ten cases, with substantial heterogeneity across studies (I² = 99%, P < 0.001). Extremely premature neonates had almost twice the risk of IVH compared to those born after 28 weeks (AOR = 1.98; 95% CI: 1.31-3.64). Antenatal corticosteroid (ANC) administration reduced IVH risk by 35% (AOR = 0.65; 95% CI: 0.08-0.78), while intubation status showed no significant effect (AOR = 1.04; 95% CI: -0.19-2.28).

Conclusions: The pooled prevalence of IVH in very preterm and very low birth weight (VLBW) neonates in Africa was considerable, affecting nearly three out of ten cases. Extremely premature neonates were almost twice as likely to develop IVH compared to those born after 28 weeks of gestation, while antenatal corticosteroid (ANC) administration significantly reduced the risk. Intubation status had no significant impact on IVH risk. These findings highlight the urgent need for healthcare professionals and policymakers to prioritize preterm care standards in Africa to improve neonatal outcomes. CRD42024499505.