What clinical practice strategies have been shown to decrease incidence rates of intraventricular haemorrhage in preterm infants?

Abstract

Aim: To answer the clinical question 'In infants about to be delivered and admitted to neonatal units, what clinical practice strategies, compared to standard care, have been shown to decrease incidence rates of intraventricular haemorrhage (IVH)?' Methods: MEDLINE via Ovid were searched for relevant articles. Results: A total of 478 articles, after the removal of duplicates, were found and screened by title and abstract. Forty full-text articles were subsequently reviewed, and 19 were included as relevant to the structured clinical question. An additional article was included based on expert advice. Conclusion: There are various levels of research evidence for clinical practice strategies to decrease the incidence rates of IVH. Higher-quality evidence suggests that antenatal corticosteroids decrease the rates of IVH, and multiple evidence-based intervention bundles implemented in the neonatal unit are associated with decreased rates of IVH.A primiparous woman has prematurely ruptured her membranes at 25 weeks' gestation, and she is expected to deliver within the next week. It is known that this baby is at a high risk of intraventricular haemorrhage (IVH) due to prematurity. The treating team wish to minimise the chance of an IVH. What is the evidence for specific clinical practice strategies that may decrease the risk of an IVH in this situation? Structured Clinical QuestionIn an expected preterm infant who is about to be delivered at 25 weeks' gestation and then admitted to a neonatal unit (patient), what clinical practice strategies (intervention) lead to decreased rates of any grade of IVH (outcome)?

Analysis of risk factors of early intraventricular hemorrhage in very-low-birth-weight premature infants: a single center retrospective study

“…Glucocorticoids, as drugs to promote fetal lung maturation, have been widely used for the prevention of neonatal respiratory distress syndrome. In recent years, many studies have found that antenatal glucocorticoid use can reduce the incidence of IVH in premature infants [10,[40][41][42]. This may be due to the role of glucocorticoids in facilitating fetal vasoconstriction and alleviating fetal vasodilation, which would have been a cause of IVH during the hypercapnic state [40].…”

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

“…The management strategies contributing to the occurrence of sIVH [16], include outborn neonatal transport [17], handling and minimizing elevations of blood pressure, midline head positioning etc.. Studies have demonstrated potentially beneficial practices for the prevention of sIVH in preterm infants include improved antenatal corticosteroid use, early noninvasive ventilation, delayed cord clamping, and risk-based indomethacin prophylaxis [18][19][20][21][22]. Other studies suggest that there is lower mortality of VPIs at 2 years or better neurological outcomes in the NICUs with higher proportions of free of mechanical ventilation at 24 h of life, early enteral feeding, and consistent neurodevelopmental care practices [3,23].…”

Increasing Sodium Variability in the First 96 Hours after Birth is Associated with Adverse In-Hospital Outcomes of Preterm Newborns

“…Intraventricular hemorrhage (IVH) remains an important and potentially preventable cause of long-term neurocognitive morbidity in preterm infants. Strategies to reduce the risk of IVH during the most vulnerable 72 h after birth frequently include midline positioning and minimizing handling, including deferring daily weights [ 1 ]. With deferred daily weighing, infants are weighed at birth and then the next weight is typically obtained on day 4.…”