Application of a Bundle in the Prevention of Peri-Intraventricular Hemorrhage in Preterm Newborns

Ferreira, Daniela Monteiro; Girão, Ana Lívia Araújo; Silva, Ana Valeska Siebra E; Chaves, Edna Maria Camelo; Almeida, Paulo César de; Freire, Vanessa Emille Carvalho de Sousa; Carvalho, Rhanna Emanuela Fontenele Lima de

doi:10.1097/jpn.0000000000000482

Cited by 14 publications

(7 citation statements)

References 17 publications

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“…Higher antenatal steroid coverage may be one of the reasons for lower IVH and PVL in triplet or higher-order multiple births. Over the last several years, changes in the neonatal practices, including better ventilation strategies [ 33 , 39 , 40 ] and adherence to various IVH prevention bundles [ 41 , 42 ], are shown to be associated with an improvement in the incidence of IVH and PVL among preterm patients.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of multiple gestation births compared to singleton: analysis of multicenter KID database

Thekkeveedu

Dankhara

Desai

et al. 2021

matern health, neonatol and perinatol

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Background The available data regarding morbidity and mortality associated with multiple gestation births is conflicting and contradicting. Objective To compare morbidity, mortality, and length of stay (LOS) outcomes between multiple gestation (twin, triplet and higher-order) and singleton births. Methods Data from the national multicenter Kids’ Inpatient Database of the Healthcare Cost and Utilization Project from the years 2000, 2003, 2006, 2009, 2012, and 2016 were analyzed using a complex survey design using Statistical Analysis System (SAS) 9.4 (SAS Institute, Cary NC). Neonates with ICD9 and ICD10 codes indicating singletons, twins or triplets, and higher-order multiples were included. Mortality was compared between these groups after excluding transfer outs to avoid duplicate inclusion. To analyze LOS, we included inborn neonates and excluded transfers; who died inpatient and any neonates who appear to have been discharged less than 33 weeks PMA. The LOS was compared by gestational age groups. Results A total of 22,853,125 neonates were analyzed for mortality after applying inclusion-exclusion criteria; 2.96% were twins, and 0.13% were triplets or more. A total of 22,690,082 neonates were analyzed for LOS. Mean GA, expressed as mean (SD), for singleton, twins and triplets, were 38.30 (2.21), 36.39 (4.21), and 32.72 (4.14), respectively. The adjusted odds for mortality were similar for twin births compared to singleton (aOR: 1.004, 95% CI:0.960–1.051, p = 0.8521). The adjusted odds of mortality for triplet or higher-order gestation births were higher (aOR: 1.33, 95% CI: 1.128–1.575, p = 0.0008) when compared to the singleton births. Median LOS (days) was significantly longer in multiple gestation compared to singleton births overall (singletons: 1.59 [1.13, 2.19] vs. twins 3.29 [2.17, 9.59] vs. triplets or higher-order multiples 19.15 [8.80, 36.38], p < .0001), and this difference remained significant within each GA category. Conclusion Multiple gestation births have higher mortality and longer LOS when compared to singleton births. This population data from multiple centers across the country could be useful in counseling parents when caring for multiple gestation pregnancies.

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Section: Discussionmentioning

confidence: 99%

Outcomes of multiple gestation births compared to singleton: analysis of multicenter KID database

Thekkeveedu

Dankhara

Desai

et al. 2021

matern health, neonatol and perinatol

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show abstract

“…It occurs in about 45% of extremely preterm infants with a birth weight of <750 g and in about 52% of preterm infants born at <28 weeks' gestation ( 4 , 5 ). About 50% of cases of IVH occur within 1 day after birth, and about 90% occur within 3 days of life ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

The Impact of Different Degrees of Intraventricular Hemorrhage on Mortality and Neurological Outcomes in Very Preterm Infants: A Prospective Cohort Study

et al. 2022

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ObjectiveIntraventricular hemorrhage (IVH) is a common complication in preterm infants and is related to neurodevelopmental outcomes. Infants with severe IVH are at higher risk of adverse neurological outcomes and death, but the effect of low-grade IVH remains controversial. The purpose of this study was to evaluate the impact of different degrees of IVH on mortality and neurodevelopmental outcomes in very preterm infants.MethodsPreterm infants with a gestational age of <30 weeks admitted to neonatal intensive care units were included. Cerebral ultrasound was examined repeatedly until discharge or death. All infants were followed up to 18–24 months of corrected age. The impact of different grades of IVH on death and neurodevelopmental disability was assessed by multiple logistic regression.ResultsA total of 1,079 preterm infants were included, and 380 (35.2%) infants had grade I-II IVH, 74 (6.9%) infants had grade III-IV IVH, and 625 (57.9%) infants did not have IVH. The mortality in the non-IVH, I-II IVH, and III-IV IVH groups was 20.1, 19.7, and 55.2%, respectively (p < 0.05), and the incidence of neurodevelopmental disabilities was 13.9, 16.1, and 43.3%, respectively (p < 0.05), at 18–24 months of corrected age. After adjusting for confounding factors, preterm infants with III-IV IVH had higher rates of cerebral palsy [26.7 vs. 2.4%, OR = 6.10, 95% CI (1.840–20.231), p = 0.003], disability [43.3 vs. 13.9%, OR = 2.49, 95% CI (1.059–5.873), p = 0.037], death [55.2 vs. 20.1%, OR = 3.84, 95% CI (2.090–7.067), p < 0.001], and disability + death [73.7 vs. 28.7%, OR = 4.77, 95% CI (2.518–9.021), p < 0.001] compared to those without IVH. However, the mortality and the incidence of neurodevelopmental disability in infants with I-II IVH were similar to those without IVH (p > 0.05).ConclusionsSevere IVH but not mild IVH increased the risk of mortality and neurodevelopmental disability in very preterm infants.

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“…Widely accepted practices related to such management include (1) maintaining a supine midline with a neutral head position [ 58 ]; (2) tilting the incubator to 10° to 30° to avoid the head-down position [ 58 ]; (3) ensuring minimal handling, including suction [ 69 ]; (4) avoiding rapid flushes and blood withdrawal through intravenous or arterial routes [ 97 ]; (5) avoiding routine endotracheal suction [ 69 ]; and (6) initiating additional intervention for pain or stress relief in the form of non-nutritive sucking and oral breast milk or sucrose [ 41 ]. Several studies have indicated that neonatal neuroprotective care bundles that incorporate these practices can reduce the incidence and severity of IVH; however, studies that have applied such practices have obtained inconsistent results [ 23 , 34 , 39 , 85 ]. Therefore, additional studies are required to develop optimal management practices.…”

Section: Postnatal Strategymentioning

confidence: 99%

Pathogenesis and Prevention of Intraventricular Hemorrhage in Preterm Infants

Tsao¹

2023

J Korean Neurosurg Soc

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Intraventricular haemorrhage (IVH) is a serious concern for preterm infants and can predispose such infants to brain injury and poor neurodevelopmental outcomes. IVH is particularly common in preterm infants. Although advances in obstetric management and neonatal care have led to a lower mortality rate for preterm infants with IVH, the IVH-related morbidity rate in this population remains high. Therefore, the present review investigated the pathophysiology of IVH and the evidence related to interventions for prevention. The analysis of the pathophysiology of IVH was conducted with a focus on the factors associated with cerebral hemodynamics, vulnerabilities in the structure of cerebral vessels, and host or genetic predisposing factors. The findings presented in the literature indicate that fluctuations in cerebral blood flow, the presence of hemodynamic significant patent ductus arteriosus, arterial carbon dioxide tension, and impaired cerebral venous drainage; a vulnerable or fragile capillary network; and a genetic variant associated with a mechanism underlying IVH development may lead to preterm infants developing IVH. Therefore, strategies focused on antenatal management, such as routine corticosteroid administration and magnesium sulfate use; perinatal management, such as maternal transfer to a specialized center; and postnatal management, including pharmacological agent administration and circulatory management involving prevention of extreme blood pressure, hemodynamic significant patent ductus arteriosus management, and optimization of cardiac function, can lower the likelihood of IVH development in preterm 4 infants. Incorporating neuroprotective care bundles into routine care for such infants may also reduce the likelihood of IVH development. The findings regarding the pathogenesis of IVH further indicate that cerebrovascular status and systemic hemodynamic changes must be analyzed and monitored in preterm infants and that individualized management strategies must be developed with consideration of the risk factors for and physiological status of each preterm infant.

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Application of a Bundle in the Prevention of Peri-Intraventricular Hemorrhage in Preterm Newborns

Cited by 14 publications

References 17 publications

Outcomes of multiple gestation births compared to singleton: analysis of multicenter KID database

Outcomes of multiple gestation births compared to singleton: analysis of multicenter KID database

The Impact of Different Degrees of Intraventricular Hemorrhage on Mortality and Neurological Outcomes in Very Preterm Infants: A Prospective Cohort Study

Pathogenesis and Prevention of Intraventricular Hemorrhage in Preterm Infants

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