Contemporary mortality of neonatal germinal matrix hemorrhage and incidence of hydrocephalus requiring cerebrospinal fluid diversion in a substantially rural patient population

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.

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. Analysis was conducted with two definitions of rurality.

A total of 162 patients met study criteria, and there were 26 (15.6%) in-hospital mortalities. Mortality was associated with younger gestational age at birth as quantified by a modified World Health Organization prematurity subcategory (odds ratio [OR] 0.5, 95% confidence interval [CI] 0.2–0.9, p = .04) and with higher grade GMH-IVH (OR 1.8, 95% CI 1.2–2.7, p = .007). Permanent CSF diversion was associated with higher grade GMH-IVH (OR 8.7, 95% CI 3.2–40.4, p < .001). Rurality did not meet univariable screening criteria for logistic regression and was considered non-significant.

The mortality rates of this substantially rural cohort 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.