Evaluating the Effect of a Neonatal Care Bundle for the Prevention of Intraventricular Hemorrhage in Preterm Infants

Abstract

Germinal matrix intraventricular hemorrhage (IVH) remains a severe and common complication in preterm infants. A neonatal care bundle (NCB) was implemented as an in-house guideline at a tertiary neonatal intensive care unit to reduce the incidence of IVH in preterm infants. The NCB was applied either to preterm infants <1250 g birth weight or <30 weeks gestational age or both, and standardized patient positioning, nursing care, and medical procedures within the first week of life. A retrospective cohort study was performed to investigate the effect of the NCB and other known risk factors on the occurrence and severity of IVH. Data from 229 preterm infants were analyzed. The rate of IVH was 26.2% before and 27.1% after implementing the NCB. The NCB was associated neither with reducing the overall rate of IVH (odds ratio (OR) 1.02; 95% confidence interval (CI) 0.57–1.84; p = 0.94) nor with severe IVH (OR 1.0; 95% CI 0.67-1.55; p = 0.92). After adjustment for group differences and other influencing factors, amnion infection syndrome and early intubation were associated with an increased risk for IVH. An NCB focusing on patient positioning, nursing care, and medical interventions had no impact on IVH in preterm infants. Known risk factors for IVH were confirmed.

Impact of a “Brain Protection Bundle” in Reducing Severe Intraventricular Hemorrhage in Preterm Infants <30 Weeks GA: A Retrospective Single Centre Study

“…Our findings are in keeping with the study by Gross et al [41] who evaluated the effectiveness of a neonatal care bundle similar to our "brain protection bundle" to reduce the rate of IVH and failed to demonstrate any difference in the overall and severe grades of IVH. However, they are in contrast to several other quality improvement (QI) studies that have targeted initiatives to reduce IVH or short-term neonatal outcomes with varying degrees of success [22][23][24][25] Schmid et al demonstrated that the introduction and prospective monitoring of bundle of care practices developed on the basis of risk factors reduced the overall rate of IVH (from 22.1 to 10.5%) and severe IVH (from 9.1 to 3.7%) over a period of 23 months.…”

Evaluating the Effect of a Neuro-protective Care Bundle for Neonatal Nurses on Rate of Seriousness of Intraventricular Hemorrhage among Preterm Infants

“…This was confirmed by Yeo, et al, (2020), who stated that early gestational age and low birth weight increase the risk of IVH in preterm infants. These findings are consistent with findings from various other studies (Gross, et al, 2021;Kolnik, et al, 2023).…”

Global incidence proportion of intraventricular haemorrhage of prematurity: a meta-analysis of studies published 2010–2020

“…A review of studies published in 2021 not included in our meta-analysis reported a wide range of incidences and GA inclusion criteria, demonstrating the significant heterogeneity in the literature: any IVH 13%–40% for GA 28–29 weeks,23 24 27% for GA <30 weeks,25 25%–29% for GA <32 weeks,23 12% for GA <34 weeks26 and 2% for GA 34–35 weeks;27 sIVH 29% for GA 22–24 weeks and 9% for GA 25–28 weeks,28 15%–29% for GA <32 weeks29 30 and 4% for GA <34 weeks 26. A systematic literature review of global incidence of sIVH between 2006 and 2017 ranged from 5% to 52% (our 95% CI for this age group was 13% to 17%) with the majority of studies reporting incidence <20% 7…”