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Prevention of severe brain injury in very preterm neonates: A quality improvement initiative
Vivek V Shukla1, Andrew Klinger2, Siamak Yazdi2
1University of Alabama at Birmingham, Birmingham, AL, USA. vshukla@uabmc.edu.
Insights
A neuroprotection bundle significantly reduced severe brain injury and early death in very preterm infants. This quality improvement initiative demonstrated a crucial decrease in adverse outcomes for this vulnerable population.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Critical Care Medicine
Background:
- Very preterm infants face high risks of severe brain injury and early mortality.
- Existing neuroprotection strategies require comprehensive evaluation for efficacy.
Purpose of the Study:
- To assess the impact of a comprehensive neuroprotection interventions bundle on severe brain injury or early death in very preterm infants.
- To evaluate the effectiveness of a multi-faceted approach to neonatal brain protection.
Main Methods:
- A prospective quality improvement initiative was conducted from April 2017 to September 2019.
- The neuroprotection bundle included cerebral NIRS, TcCO2, and HeRO monitoring, indomethacin prophylaxis, protocolized bicarbonate and inotropes, noise reduction, and neutral positioning.
- Outcomes were compared pre-intervention and during the intervention period.
Main Results:
- The incidence of the primary composite outcome (severe brain injury or early death) significantly decreased.
- Unadjusted analysis showed a reduction from 11/99 to 0/127 infants (p < 0.001).
- Adjusted analysis confirmed a significant decrease (aOR = 0.042, p = 0.024).
Conclusions:
- The neuroprotection interventions bundle was associated with a significant reduction in severe brain injury or early death.
- This comprehensive bundle represents an effective strategy for improving outcomes in very preterm infants.
- Implementation of this bundle can enhance neonatal neuroprotection and reduce mortality.
Objective:
To determine the impact of neuroprotection interventions bundle on the incidence of severe brain injury or early death (intraventricular hemorrhage grade 3/4 or death by 7 days or ventriculomegaly or cystic periventricular leukomalacia on 1-month head ultrasound, primary composite outcome) in very preterm (270/7 to ≤ 296/7 weeks gestational age) infants.
Study Design:
Prospective quality improvement initiative, from April 2017-September 2019, with neuroprotection interventions bundle including cerebral NIRS, TcCO2, and HeRO monitoring-based management algorithm, indomethacin prophylaxis, protocolized bicarbonate and inotropes use, noise reduction, and neutral positioning.
Result:
There was a decrease in the incidence of the primary composite outcome in the intervention period on unadjusted (N = 11/99, pre-intervention to N = 0/127, intervention period, p < 0.001) and adjusted analysis (adjusted for birthweight and Apgar score <5 at 5 min, aOR = 0.042, 95% CI = 0.003-0.670, p = 0.024).
Conclusions:
Neuroprotection interventions bundle was associated with significant decrease in severe brain injury or early death in very preterm infants.
