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Impact of a Structured Brain Care Bundle on Severe Germinal Matrix Hemorrhage-Intraventricular Hemorrhage in Very
Asma Almazrooei1, Yasser Balubaid1, Nisreen Alkafi1
1Neonatology Division, Pediatric Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.
Insights
Brain Care Bundles (BCBs) significantly reduced severe germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) and late-onset sepsis in very preterm infants. This quality improvement strategy enhanced care in a Middle Eastern neonatal intensive care unit.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Public Health
Background:
- Germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) is a major cause of neurodevelopmental issues in preterm infants.
- Standardized Brain Care Bundles (BCBs) show promise in reducing GMH-IVH, but data from Middle Eastern NICUs are scarce.
Purpose of the Study:
- To evaluate the effectiveness of implementing a ten-component BCB in a Middle Eastern Level III NICU.
- To assess the impact of BCBs on severe GMH-IVH rates and other neonatal morbidities.
Main Methods:
- Retrospective cohort study comparing infants before (n=80) and after (n=77) BCB implementation (≤30 weeks gestation or ≤1500g birth weight).
- Key BCB components included antenatal steroids, magnesium sulfate, delayed cord clamping, and neuroprotective measures.
- Primary outcome was severe GMH-IVH (Papile grade III-periventricular hemorrhagic infarction); secondary outcomes included sepsis, NEC, BPD, ROP, and mortality.
Main Results:
- Severe GMH-IVH incidence decreased from 15% to 5% post-BCB implementation (P=0.045).
- BCB implementation was independently associated with reduced severe GMH-IVH (aOR=0.52; P=0.048) and significantly decreased late-onset sepsis (P=0.002).
- Improved adherence to antenatal steroids and delayed cord clamping were noted post-BCB.
Conclusions:
- Implementing BCBs in a high-risk Middle Eastern NICU significantly reduced severe GMH-IVH and late-onset sepsis.
- BCBs represent a valuable quality improvement strategy for improving outcomes in vulnerable preterm infants.
- The study supports the adoption of BCBs to enhance neuroprotection and reduce morbidity in neonatal intensive care settings.
Background:
Germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) remains a leading cause of neurologic morbidity and mortality in very preterm infants. Evidence supports the assertion that standardized neuroprotective "Brain Care Bundles" (BCBs) can reduce GMH-IVH risk, but data from Middle Eastern Level III neonatal intensive care units are limited.
Methods:
We performed a retrospective cohort study comparing pre-BCBs (January-December 2021; n = 80) versus post-BCB (January-December 2022; n = 77) cohorts of inborn infants ≤30 weeks' gestation and or birth weight ≤1500 g. The ten-component BCBs included antenatal steroids, magnesium sulfate, delayed cord clamping, thermoregulation, midline head positioning, minimal handling, permissive hypercapnia, targeted oxygen saturation, hemodynamic thresholds, and neurodevelopmental support. The primary outcome was rate of severe GMH-IVH (Papile grade III-periventricular hemorrhagic infarction) on cranial ultrasound after 72 hours. Secondary outcomes included any-grade GMH-IVH, post-hemorrhagic hydrocephalus, necrotizing enterocolitis (≥stage 2), late-onset sepsis, bronchopulmonary dysplasia, retinopathy of prematurity (≥stage 3), and mortality.
Results:
Baseline demographics were comparable except for a higher male proportion in the pre-BCBs cohort (63.7% vs 44.0%; P = 0.017). Delayed cord clamping and completion of antenatal steroids improved significantly post-BCBs (P < 0.05). Severe GMH-IVH incidence declined from 15% to 5% (AR = 10.2%; P = 0.045); BCBs implementation remained independently protective in multivariable analysis (adjusted odds ratio = 0.52; 95% confidence interval: 0.27-0.99; P = 0.048). Late-onset sepsis decreased markedly (P = 0.002). No significant differences were found in rates of necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity, hydrocephalus, or mortality.
Conclusions:
Implementation of the BCBs in a high-risk Middle Eastern neonatal intensive care unit was associated with significantly reduced severe GMH-IVH and late-onset sepsis, along with better antenatal steroid adherence. These results support adopting neuroprotective BCBs as a quality improvement strategy in vulnerable preterm populations.
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