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Reducing Severe Intraventricular Hemorrhage in Preterm Infants With Improved Care Bundle Adherence
Sarah E Kolnik1, Kirtikumar Upadhyay1, Thomas R Wood1,2
1Division of Neonatology, University of Washington/Seattle Children's Hospital, Seattle, Washington.
Insights
Improving adherence to intraventricular hemorrhage prevention bundles (IVHPs) significantly reduced severe IVH rates in premature infants. This highlights the critical role of clinical guideline adherence in neonatal care.
Area of Science:
- Neonatal Medicine
- Clinical Quality Improvement
- Pediatric Critical Care
Background:
- High incidence of severe intraventricular hemorrhage (IVH) (9.8%) and low adherence (24%) to IVH prevention bundles (IVHPBs) were observed in high-risk neonates.
- Initiatives were planned to reduce severe IVH by 30% over two years in infants born at or before 30 gestational weeks or weighing ≤1250 g.
Purpose of the Study:
- To decrease the incidence of severe (grade III/IV) intraventricular hemorrhage (IVH) in premature infants.
- To improve adherence to an established IVH prevention bundle (IVHPB).
Main Methods:
- A multidisciplinary team implemented interventions including training, guideline revision, and process standardization.
- Adherence to the IVHPB was the primary process measure, and severe IVH incidence was the primary outcome measure.
- Control charts analyzed intervention effects, with balancing measures including breast milk use and mechanical ventilation rates.
Main Results:
- Adherence to the IVHPB increased from 24% to 88% following interventions.
- The incidence of severe IVH decreased by 76%, from 9.8% to 2.4%.
- Higher adherence scores correlated with reduced odds of severe IVH (OR 0.30).
Conclusions:
- Interventions enhancing adherence to IVH prevention bundles significantly reduced severe IVH rates in high-risk neonates.
- Assessing and improving adherence to clinical guidelines is crucial for optimizing neonatal outcomes.
Background And Objectives:
Intraventricular hemorrhage prevention bundles (IVHPBs) can decrease the incidence of intraventricular hemorrhage (IVH) in premature infants. Our center had a high rate of severe (grade III/IV) IVH (9.8%), and poor adherence (24%) to an IVHPB in neonates born ≤1250 g or ≤30 gestational weeks. Improvement initiatives were planned to decrease the incidence of severe IVH by 30% over 2 years.
Methods:
A multidisciplinary team undertook interventions including in-service training, prompt initiation of IVHPB, revision of guidelines, and process standardization. Baseline data were collected from May 2016 to June 2018, with interventions occurring from July 2018 to May 2020. Adherence to the IVHPB was the primary process measure, and incidence of severe IVH the primary outcome measure. Control charts were used to analyze the effect of interventions on outcome. Balancing measures included use of breast milk at discharge, use of mechanical ventilation after initial resuscitation, and bronchopulmonary dysplasia.
Results:
A total of 240 infants were assessed preintervention, and 185 during interventions. Adherence to the IVHPB improved from 24% to 88%. During this period, the incidence of severe IVH decreased from 9.8% to 2.4%, a 76% reduction from baseline. A higher adherence score was associated with reduced odds of IVH (odds ratio 0.30; 95% confidence interval 0.10-0.90, P = .03).
Conclusions:
Interventions focused on enhancing adherence to an IVHPB were associated with a reduced rate of severe IVH in high-risk neonates, highlighting the importance of assessing adherence to clinical guidelines.
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