Impact of bundle implementation on the incidence of peri/intraventricular hemorrhage among preterm infants: a pre-post interventional study

Abstract

BACKGROUND: Peri/intraventricular hemorrhage (PIVH) is a frequent cause of death and morbidity among preterm infants. Few studies have addressed the use of bundles for preventing PIVH. OBJECTIVE: To evaluate the efficacy of a bundle of interventions designed to decrease the incidence of intraventricular hemorrhage at hospital discharge among preterm infants. DESIGN AND SETTING: Pre-post interventional study with retrospective and prospective data collection performed before and after bundle implementation in the neonatal intensive care unit of a university hospital. METHODS: Infants with gestational age < 32 weeks without malformations, who survived > 6 days were included. The bundle consisted of the following actions during the first 72 hours of life: maintenance of head in neutral position with the body in supine position, minimal handling, including delay of lumbar puncture until after 72 hours and absence of respiratory therapy maneuvers. Cranial ultrasound was performed on days 3, 7 and 28, or later if needed. The effect of the bundle was analyzed through logistic regression and results were adjusted for confounding variables. RESULTS: 167 infants met the inclusion criteria; 146 (87%) were analyzed. Bundle implementation was associated with decreased chances of PIVH at hospital discharge (odds ratio 0.29; 95% confidence interval 0.13-0.65). Cerebrospinal fluid collection within the first 72 hours increased the odds of PIVH of any grade during the hospital stay fourfold, after adjustment for all variables included in the model. CONCLUSION: Implementation of a bundle of interventions to avoid intraventricular hemorrhage was effective for decreasing the incidence of all grades of PIVH in preterm infants.

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…”

Prevalence of intraventricular haemorrhage and determinants of its early outcomes among preterm neonates at the newborn unit of a teaching hospital in Western Kenya

“…Because of this and the high interest in child health evidenced by national strategies has led to an increased investment and development in neonatal care so as to improve survival rates [10]. The resulting high number of preterm, very low birth weight (VLBW) and extremely low birth weight (ELBW) newborns increases the risk of intracranial bleeding occurring, and intraventricular haemorrhage (IVH) in particular; with neonates born <32 weeks gestation age (GA) or <1500g being more susceptible [11,12]. While IVH contributes significantly to poor outcomes in mortality, morbidity, cognitive and motor neurological development, there is little data in its incidence, risk factors and complications in LICs as compared to high income countries [12].…”