OC 52.1 - Mode of delivery and intracranial hemorrhage in newborns with hemophilia: A Systematic Review and Meta-analysis

Tuesday, July 12, 2022

10:45 AM – 11:00 AM

Location: ExCel Center, S11B

Presentation Format: In-Person

Presenting Author(s)

NR

Nisarg Radadia

Master Student
McMaster University
Cambridge, Ontario, Canada

Co-Author(s)

DV

Disha Vyas

Undergraduate Student
University of North Carolina Greensboro
Greensboro, North Carolina, United States
ET

Elisabetta Trinari

Assistant Professor
University of McMaster
Hamilton, Ontario, Canada
Anthony K. Chan, MBBS, FRCP (C), MBBS

Pediatric Hematologist
Department of Pediatrics, McMaster Children's Hospital
Hamilton, Ontario, Canada
JP

Jo-Ann Petropoulos

Librarian
McMaster University
Hamilton, Ontario, Canada
MB

Mihir D. Bhatt, MD

Pediatric Hematologist
McMaster Children’s Hospital
Hamilton, Ontario, Canada

Background: Newborns with hemophilia have 44-60 times higher risk of neonatal intracranial hemorrhage (ICH). Mode of delivery has been explored as a prevention strategy. While initial small studies and meta-analysis of 3 studies by Davies & Kadir (2015) suggested beneficial effect of caesarian section (CS) compared to spontaneous vaginal delivery (SVD), subsequent literature has reported no difference.

Aims: To perform a systematic review and meta-analysis to compare odds of neonatal ICH in newborns with hemophilia born via CS and assisted VD (AVD) to SVD.

Methods: Systematic search of literature in MEDLINE, EMBASE, CINAHL, and Web of Science from inception to 2021. Abstracts and full texts were screened by two independent reviewers based on pre-set inclusion/exclusion criteria. Risk of bias was evaluated using Newcastle Ottawa Scale (NOS). Heterogeneity was assessed using Cochran’s Q test and I2 statistic and studies were assigned appropriate weight based on a random-effects model. Meta-analysis was conducted using SPSS software© and effect sizes were compared using odds ratios with p-value < 0.5 considered significant.

Results: Search yielded 1756 articles; 11 were included in final meta-analysis (Figure.1). Of 2842 patients among 11 studies, 1864(66%) were born via SVD, 784(28%) CS, and 194(6%) AVD; 68(2.4%) suffered neonatal ICH. Based on NOS, 10 studies were deemed ‘good’ quality and 1 ‘fair’ quality. Heterogeneity was small with Cochran’s Q of 11.29 and I2 statistic of 0.20. The odds of neonatal ICH with CS were similar to SVD (pooled OR: 1.27, 95%CI: 0.66-2.46) (Figure.2A). The odds of neonatal ICH with AVD were much higher compared to SVD (pooled OR: 12.88, 95%CI: 6.14-27.00) (Figure.2B).

Conclusion(s): Unlike previous reports, this larger meta-analysis shows that CS is not associated with reduced risk of neonatal ICH when compared to SVD. As known, higher risk of neonatal ICH with AVD compared to SVD was confirmed.