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Impact of ultrasound-guided circulatory management protocol on intraventricular hemorrhage in extremely preterm
Hirosato Aoki1, Tomoyuki Kamamoto2, Naoki Ozu3
1Division of Neonatal Intensive Care, Center of Perinatal Medicine, Nara Medical University Hospital, Kashihara, Japan. hirosatoa@naramed-u.ac.jp.
Insights
An ultrasound-guided protocol significantly reduced intraventricular hemorrhage (IVH) in extremely preterm infants. This approach improved hemodynamic stability, protecting vulnerable newborns during their critical first days.
Area of Science:
- Neonatalogy
- Pediatric Cardiology
- Medical Ultrasound
Background:
- Intraventricular hemorrhage (IVH) is a critical complication in extremely preterm infants.
- The initial 72 hours of life are crucial for these vulnerable neonates.
Purpose of the Study:
- To evaluate the impact of an ultrasound-guided circulatory management protocol on IVH incidence.
- To assess the effectiveness of tailored hemodynamic management in extremely preterm infants.
Main Methods:
- Retrospective study of infants born before 28 weeks gestation.
- Implementation of a protocol with daily ultrasounds, tailored sedation, and nitroglycerin use guided by hemodynamic findings.
- Comparison of clinical outcomes and blood pressure trends pre- and post-protocol implementation.
Main Results:
- Overall IVH incidence decreased from 37% to 9% (p=0.002).
- Severe IVH incidence declined from 16% to 2% (p=0.03).
- Slower blood pressure increases and reduced variability observed post-implementation without increased hypotension.
Conclusions:
- Ultrasound-guided circulatory management significantly reduces IVH in extremely preterm infants.
- The protocol enhances hemodynamic stability, supporting brain protection.
- Ultrasound utilization by neonatologists is a feasible, individualized approach for optimizing care.
Background:
Intraventricular hemorrhage (IVH) is a serious complication in extremely preterm infants, in whom the first 72 hours of life are critical. We evaluated the impact of an ultrasound-guided circulatory management protocol on IVH incidence.
Methods:
This retrospective study included infants who were born before 28 weeks of gestation and admitted to a tertiary neonatal intensive care unit between January 2018 and September 2024. In June 2022, a new protocol was introduced that incorporated three daily ultrasound assessments, adequate and tailored sedation, and targeted nitroglycerin use guided by ultrasound hemodynamic findings. Clinical outcomes and blood pressure trends were compared between the pre- and post-implementation groups.
Results:
Ninety-two infants (49 pre-implementation and 43 post-implementation) were analyzed. The incidence of overall IVH decreased from 37% to 9% (p = 0.002), and severe IVH declined from 16% to 2% (p = 0.03). After implementation, increases in blood pressure were slower, and variability was reduced. No increase in hypotension duration or adverse outcomes was observed.
Conclusion:
After the implementation of the ultrasound-guided circulatory management protocol, the IVH incidence significantly decreased. These findings also support the potential of ultrasound by neonatologists in the circulatory management of extremely preterm infants.
Impact Statement:
An ultrasound-guided circulatory management protocol reduced the incidence of intraventricular hemorrhage in extremely preterm infants. The protocol included frequent cardiac and cranial ultrasound assessments, adequate and tailored sedation, and selective nitroglycerin use guided by real-time ultrasound hemodynamic findings. After implementation, blood pressure rose more gradually and fluctuated less, indicating improved hemodynamic stability. These findings support a feasible, individualized approach to protect the immature brain during the most vulnerable period. The study also highlights the potential role of ultrasound by neonatologists in optimizing the care for extremely preterm infants.
