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A FAR-Out approach for evaluating the impact of clinical practice changes on severe intracranial hemorrhage in

Ronald I Clyman1,2, Nancy K Hills3,4

  • 1Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA. clymanr@peds.ucsf.edu.

Journal of Perinatology : Official Journal of the California Perinatal Association
|January 19, 2026
PubMed

Insights

A new framework, FAR-Out, tracks risk differences in preterm infants. It found that infant immaturity, not practice adherence, primarily impacts severe intraventricular hemorrhage or early death rates.

Area of Science:

  • Neonatalogy
  • Clinical Epidemiology
  • Biostatistics

Background:

  • Severe intraventricular hemorrhage (sIVH) and early death remain critical concerns in preterm infants.
  • Understanding the interplay of clinical interventions and physiologic factors is crucial for improving outcomes.
  • Existing frameworks may not adequately capture dynamic risk variations over time.

Purpose of the Study:

  • To develop and validate a novel organizational framework, the Frequency-Adjusted-Risk-difference-versus-OUTcome (FAR-Out) approach.
  • To examine the individual contributions of modifiable and non-modifiable factors on sIVH (grades 3/4) or death within 4 days.
  • To assess changes in sIVH/death rates following the implementation of improved-practice guidelines in a preterm cohort.

Main Methods:

  • Development of the FAR-Out approach to analyze risk differences and frequencies across defined study epochs.
  • Application of FAR-Out to a cohort of 537 preterm infants (230/7-276/7 weeks gestation).
  • Correlation analysis between FAR-Out Risk Scores and sIVH/death<4 days rates (Pearson's r = 0.974).

Main Results:

  • FAR-Out Risk Scores demonstrated a strong epoch-to-epoch correlation with sIVH/death<4 days rates.
  • Post-guideline implementation, changes in sIVH/death<4 days rates were predominantly linked to non-modifiable risks like immaturity and illness severity.
  • Fluctuations in adherence to modifiable practices showed a lesser association with observed outcome rate variations.

Conclusions:

  • The strong correlation supports the FAR-Out approach as a valuable tool for analyzing dynamic risk factors.
  • The findings highlight the significant impact of inherent infant characteristics on sIVH/death<4 days.
  • This framework can help differentiate the influence of clinical practice changes versus intrinsic patient factors on neonatal outcomes.
Abstract

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