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Neuroprotection Care Bundle Implementation to Decrease Acute Brain Injury in Preterm Infants
Prashanth Murthy1, Hussein Zein1, Sumesh Thomas1
1Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
Insights
Implementing a neuroprotection care bundle significantly reduced the risk of brain injury and death in extremely preterm infants. This evidence-based approach proved feasible and effective in improving outcomes for vulnerable newborns.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Evidence-Based Practice
Background:
- Extremely preterm infants (born <29 weeks gestation) are at high risk for acute brain injury.
- Existing evidence supports neuroprotection interventions to mitigate brain injury risk factors.
Purpose of the Study:
- To assess the impact of an evidence-based neuroprotection care bundle on brain injury risk in extremely preterm infants.
- To evaluate the feasibility and effectiveness of implementing a comprehensive neuroprotection strategy.
Main Methods:
- A neuroprotection care bundle including minimal handling, midline head position, deferred cord clamping, and optimized hemodynamic/respiratory management was implemented.
- Interventions targeted risk factors during the first three days of life.
- A pre-implementation and post-implementation comparison of the composite outcome of acute preterm brain injury or death was conducted.
Main Results:
- Bundle implementation significantly reduced risk factors: inotrope use (24% to 7%), fluid boluses (37% to 19%), pneumothorax (5% to 2%), and opioid use (19% to 7%).
- The neuroprotection care bundle significantly reduced death or severe brain injury (aOR 0.34) and severe brain injury (aOR 0.31) after adjusting for confounders.
Conclusions:
- Implementation of a neuroprotection care bundle is feasible in clinical settings.
- The care bundle effectively reduces acute brain injury and associated risk factors in extremely preterm infants.
- This strategy offers a promising approach to improve neurodevelopmental outcomes in this vulnerable population.
Background:
We assessed the impact of an evidence-based neuroprotection care bundle on the risk of brain injury in extremely preterm infants.
Methods:
We implemented a neuroprotection care bundle consisting of a combination of neuroprotection interventions such as minimal handling, midline head position, deferred cord clamping, and protocolization of hemodynamic and respiratory managements. These interventions targeted risk factors for acute brain injury in extremely preterm infants (born at gestational age less than 29 weeks) during the first three days of birth. Implementation occurred in a stepwise manner, including care bundle development by a multidisciplinary care team based on previous evidence and experience, standardization of outcome assessment tools, and education. We compared the incidence of the composite outcome of acute preterm brain injury or death preimplementation and postimplementation.
Results:
Neuroprotection care bundle implementation associated with a significant reduction in acute brain injury risk factors such as the use of inotropes (24% before, 7% after, P value < 0.001) and fluid boluses (37% before, 19% after, P value < 0.001), pneumothorax (5% before, 2% after, P value = 0.002), and opioid use (19% before, 7% after, P value < 0.001). Adjusting for confounding factors, the neuroprotection care bundle significantly reduced death or severe brain injury (adjusted odds ratio, 0.34; 95% confidence interval, 0.20 to 0.59; P value < 0.001) and severe brain injury (adjusted odds ratio, 0.31; 95% confidence interval, 0.17 to 0.58; P < 0.001).
Conclusions:
Implementation of neuroprotection care bundle targeting predefined risk factors is feasible and effective in reducing acute brain injury in extremely preterm infants.
