Related Experiment Video
Updated: Oct 2, 2025
Description of a Swine Infant Model of Volume-Controlled Hemorrhagic Shock
Published on: November 3, 2023
Reduction of Severe Intraventricular Hemorrhage in Preterm Infants: A Quality Improvement Project
Katelin P Kramer1,2, Kacy Minot2, Colleen Butler2
1Department of Pediatrics, University of California, San Francisco, San Francisco, California.
Insights
Implementing a quality improvement project significantly reduced severe intraventricular hemorrhage (sIVH) in extremely preterm infants. This initiative achieved a sustained reduction in sIVH rates and mortality.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Quality Improvement Science
Background:
- Severe intraventricular hemorrhage (sIVH) is a major complication in extremely preterm infants.
- Reducing sIVH rates is a critical goal in neonatal intensive care.
Purpose of the Study:
- To decrease the incidence of severe intraventricular hemorrhage (sIVH) by 50% in extremely preterm infants.
- To implement and sustain evidence-based interventions over a 3-year period.
Main Methods:
- A multidisciplinary team developed targeted interventions based on key drivers of IVH.
- Interventions included improved ventilation, antenatal betamethasone, and indomethacin prophylaxis.
- Data were collected via quarterly chart reviews and analyzed using statistical process control charts.
Main Results:
- The rate of sIVH decreased from 14% to 1.2% in extremely preterm infants.
- This reduction was sustained for over two and a half years.
- Mortality also decreased by 50% without an increase in other morbidities.
Conclusions:
- A multipronged quality improvement approach effectively reduced sIVH in extremely preterm infants.
- Evidence-based guidelines, consistent prophylaxis, and reduced early intubation were key to success.
- The project demonstrated sustained improvement in neonatal outcomes.
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.
