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Published on: August 25, 2022
Neuroprotection Bundles and Intraventricular Hemorrhage Rates in Neonates <29 Weeks' Gestation
Poorva Deshpande1, Ipsita Goswami2, Khorshid Mohammad3
1Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
The Journal of Pediatrics
|May 28, 2026
Summary
The intraventricular hemorrhage-neuroprotection bundle (IVH-NB) improved care practices in neonatal intensive care units. However, it did not significantly reduce rates of severe intraventricular hemorrhage (IVH) or death in preterm infants.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Clinical Quality Improvement
Background:
- Intraventricular hemorrhage (IVH) is a significant concern in preterm infants, associated with adverse neurological outcomes.
- Neuroprotection bundles aim to standardize care and reduce IVH incidence.
- The effectiveness of the intraventricular hemorrhage-neuroprotection bundle (IVH-NB) on IVH rates in extremely preterm infants requires evaluation.
Purpose of the Study:
- To assess the impact of implementing the intraventricular hemorrhage-neuroprotection bundle (IVH-NB) on intraventricular hemorrhage (IVH) rates.
- To determine if IVH-NB implementation influences severe IVH, post-hemorrhagic ventricular dilatation (PHVD), or severe neurological injury in neonates born at <29 weeks' gestation.
Main Methods:
- A multicenter, retrospective, pre- and post-implementation cohort study was conducted.
- Data from 17 Canadian neonatal intensive care units (NICUs) were analyzed for 6522 infants born at <29 weeks' gestation.
- Primary outcome was a composite of severe IVH (grade III/IV) or death within 7 days; secondary outcomes included severe IVH, PHVD, and severe neurological injury.
Main Results:
- Implementation of IVH-NB was associated with increased use of deferred cord clamping, prophylactic indomethacin, and normothermia, and decreased cardiopulmonary resuscitation and endotracheal intubation at birth.
- No significant changes were observed in the adjusted odds ratios for the composite outcome, severe IVH, or PHVD post-implementation.
- Early treatment of patent ductus arteriosus (PDA), adopted by two sites, was the only bundle component linked to improved outcomes (aOR 0.30).
Conclusions:
- The IVH-NB implementation led to positive changes in clinical practices within NICUs.
- Despite practice improvements, the IVH-NB did not demonstrate a significant reduction in severe IVH or associated adverse outcomes in this cohort.
- Further research may be needed to refine neuroprotection strategies for extremely preterm infants.
