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The effectiveness of interventions to prevent intraventricular haemorrhage in premature infants: A systematic review
Si Liang Yao1, Elisa Smit1,2, David Odd1,2
1Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
Insights
Intraventricular haemorrhage (IVH) prevention in preterm infants remains unclear. While vitamin E and indomethacin showed promise, further research is needed to identify effective interventions for reducing IVH incidence.
Area of Science:
- Neonatal Medicine
- Clinical Trials
- Evidence-Based Medicine
Background:
- Intraventricular haemorrhage (IVH) is a significant cause of morbidity and mortality in preterm infants.
- Current strategies for IVH prevention lack definitive evidence of efficacy.
- This study addresses the need for a comprehensive comparison of various interventions to prevent IVH.
Approach:
- A systematic network meta-analysis was conducted, synthesizing data from 40 randomized controlled trials.
- The search encompassed major databases including MEDLINE, EMBASE, Emcare, and CENTRAL.
- The Surface Under the Cumulative Ranking Curve (SUCRA) was utilized to rank intervention effectiveness.
Key Points:
- Twelve distinct intervention groups were analyzed, involving over 6760 preterm infants.
- Vitamin E and indomethacin demonstrated the highest probability of being effective in preventing IVH.
- Significant study limitations and heterogeneity complicate the interpretation of findings.
Conclusions:
- No single intervention was definitively identified as superior for preventing IVH in preterm infants.
- Heterogeneity in study populations, interventions, and evolving neonatal care practices limited the meta-analysis.
- Urgent, well-designed trials focusing on high-risk infants are necessary to establish optimal IVH prevention strategies.
Background:
Intraventricular haemorrhage (IVH) is a common problem in preterm infants, being a major cause of morbidity and mortality. Despite many randomised controlled trials comparing interventions to prevent IVH, the best prevention remains unclear. This study aims to review all the interventions which intended to reduce the incidence of IVH and compare them in a network meta-analysis.
Methods:
A search on MEDLINE, EMBASE, Emcare, and CENTRAL was performed. Randomised controlled trials which evaluated neonatal interventions with a primary aim to reduce incidence of IVH in preterm infants were eligible. A surface under a cumulative ranking curve (SUCRA) was produced to indicate the intervention's likelihood of being the most effective for preventing IVH.
Results:
40 studies were eligible, enrolling over 6760 infants. Twelve intervention groups were found, including delayed cord clamping, erythropoietin, ethamsylate, fresh frozen plasma, heparin, ibuprofen, indomethacin, magnesium, nursing interventions, sedation, tranexamic acid, and vitamin E. Vitamin E and indomethacin had the highest probability of being the best interventions to prevent IVH in premature infants, but interpretation of these results is difficult due to study limitations.
Conclusion:
Despite the impact of IVH, we were unable to identify a clearly beneficial treatment to reduce its incidence. Interpretation of the network meta-analysis was limited due to differences within studied populations, wide range of therapies trialled, and underlying advances in neonatal care between units, and over time. Although vitamin E and indomethacin appear to be promising candidates, contemporaneous trials of these, or novel agents, enrolling the most at-risk infants is needed urgently.
