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Impact of bundle implementation on the incidence of peri/intraventricular hemorrhage among preterm infants: a
Cristiane Akemi Koyama Wallau1, Daniela Testoni Costa-Nobre2, Ana Teresa Figueiredo Stochero Leslie3
1MSc. Postgraduate Student. Neonatal Division, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo (SP), Brazil.
Insights
A new care bundle effectively reduced the incidence of peri/intraventricular hemorrhage (PIVH) in preterm infants. This intervention, focused on head positioning and minimal handling, significantly lowered the risk of PIVH at hospital discharge.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Critical Care Medicine
Background:
- Peri/intraventricular hemorrhage (PIVH) is a significant cause of mortality and morbidity in preterm infants.
- Limited research exists on preventative care bundles for PIVH.
Purpose of the Study:
- To assess the effectiveness of an intervention bundle in reducing intraventricular hemorrhage (IVH) incidence in preterm infants by hospital discharge.
- To identify factors influencing IVH risk in this population.
Main Methods:
- A pre-post interventional study design was employed in a university hospital's neonatal intensive care unit.
- The intervention bundle included head/body positioning, minimal handling, delayed lumbar puncture, and avoidance of respiratory therapy maneuvers within the first 72 hours of life.
- Logistic regression analysis was used to evaluate the bundle's impact, adjusting for confounding variables.
Main Results:
- Bundle implementation was linked to a significant reduction in PIVH incidence at hospital discharge (OR 0.29; 95% CI 0.13-0.65).
- Early cerebrospinal fluid collection within 72 hours quadrupled the odds of any-grade PIVH during hospitalization.
- 146 preterm infants (gestational age < 32 weeks) were analyzed.
Conclusions:
- The implemented bundle of interventions proved effective in decreasing the incidence of all PIVH grades among preterm infants.
- Avoiding early cerebrospinal fluid collection is crucial for PIVH prevention.
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.
