Reduction of Severe Intraventricular Hemorrhage in Preterm Infants: A Quality Improvement Project

Abstract

OBJECTIVES: The aim of this quality improvement project was to reduce the rate of severe intraventricular hemorrhage (sIVH) by 50% within 3 years for extremely preterm infants born at a children’s teaching hospital. METHODS: A multidisciplinary team developed key drivers for the development of intraventricular hemorrhage in preterm infants. Targeted interventions included the development of potentially better practice guidelines, promoting early noninvasive ventilation, consistent use of rescue antenatal betamethasone, and risk-based indomethacin prophylaxis. The outcome measure was the rate of sIVH. Process measures included the rate of intubation within 24 hours and receipt of rescue betamethasone and risk-based indomethacin prophylaxis. Common markers of morbidity were balancing measures. Data were collected from a quarterly chart review and analyzed with statistical process control charts. The preintervention period was from January 2012 to March 2016, implementation period was from April 2016 to December 2018, and sustainment period was through June 2020. RESULTS: During the study period, there were 268 inborn neonates born at <28 weeks’ gestation or <1000 g (127 preintervention and 141 postintervention). The rate of sIVH decreased from 14% to 1.2%, with sustained improvement over 2 and a half years. Mortality also decreased by 50% during the same time period. This was associated with adherence to process measures and no change in balancing measures. CONCLUSIONS: A multipronged quality improvement approach to intraventricular hemorrhage prevention, including evidence-based practice guidelines, consistent receipt of rescue betamethasone and indomethacin prophylaxis, and decreasing early intubation was associated with a sustained reduction in sIVH in extremely preterm infants.

Preterm Brain Injury and Neurodevelopmental Outcomes: A Meta-analysis

“…These improvements have resulted in considerable survival gains for preterm infants, and many have also been neuroprotective, and as such, have reduced the rate and severity of preterm brain injuries. [4][5][6][7][8][9] Therefore, the relationship between neurodevelopmental impairment and brain injuries of prematurity may be different to that described previously.…”

The performance of the practices associated with the occurrence of severe intraventricular hemorrhage in the very premature infants: data analysis from the Chinese neonatal network

“…Studies suggest that optimal care practices [32] or the application of neonatal care bundles [18] could significantly reduce risk of developing sIVH and the critical care time was from the perinatal period to the first 3 DOL [27]. However, there are few studies to systemically investigate the associations between the practices and the occurrences of sIVH in detail.…”

Indomethacin Prophylaxis Is Associated with Reduced Risk of Intraventricular Hemorrhage in Extremely Preterm Infants Born in the Context of Amniotic Infection Syndrome

“…It has been proposed as well that this risk reduction is most prominent in the most vulnerable group of preterm infants [27]. A recent study from Kramer et al [28] underlines these findings by introducing a bundle of quality improvement measures for IVH prevention that lead to a sustained reduction in IVH in extremely preterm infants. A recent meta-analysis revealed a reduction of severe IVH due to a prophylactic therapy with indomethacin [10] which is supported by data from the Canadian Neonatal Network with similar gestational age strata to our study cohort [29].…”