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Best evidence summary for the prevention of intraventricular hemorrhage in preterm infants: a systematic review
Liya Wu1, Dan Zhang1, Juan Ye1
1Nursing Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Insights
This study synthesizes evidence on preventing intraventricular hemorrhage (IVH) in preterm infants. Implementing these findings requires careful consideration of local resources and policies for effective evidence-based care.
Area of Science:
- Neonatal Intensive Care
- Perinatal Medicine
- Evidence-Based Practice
Background:
- Intraventricular hemorrhage (IVH) is a severe complication of prematurity, despite advances in neonatal care.
- IVH is linked to mortality and long-term neurodevelopmental issues in preterm infants.
- Preventive interventions show promise in reducing IVH incidence and severity.
Purpose of the Study:
- To systematically retrieve and synthesize the best available evidence on preventing IVH in preterm infants.
- To provide practical references for perinatal and neonatal intensive care professionals.
- To establish a foundation for evidence-based clinical practice in IVH prevention.
Main Methods:
- A systematic search was conducted using the "6S" evidence pyramid model across multiple databases and resources.
- Included evidence types: clinical decisions, guidelines, systematic reviews, expert consensus, best practice reports, and RCTs.
- Evidence was extracted, summarized, and graded from January 2015 to December 2025.
Main Results:
- 20 publications were included, yielding 46 pieces of best evidence.
- Evidence was synthesized across ten domains: prevention principles, risk factors, antenatal/postnatal care, thermoregulation, oxygen, blood pressure, glycemic management, care bundles, and training.
- Key areas cover comprehensive strategies from prenatal preparation to postnatal management.
Conclusions:
- The synthesis provides a robust evidence base for IVH prevention in preterm infants.
- Clinical implementation may face challenges related to healthcare policies, equipment, and human resources.
- Practitioners should carefully assess evidence context, grading, and institutional adaptability for effective application.
Background:
With continuous advances in neonatal intensive care, the survival of preterm infants has improved substantially. However, intraventricular hemorrhage (IVH) remains one of the most serious complications of prematurity and is associated with death and long-term neurodevelopmental impairment. A growing body of evidence suggests that timely preventive interventions can reduce the incidence and severity of IVH. This study aimed to systematically retrieve, appraise, and synthesize the best available evidence on IVH prevention in preterm infants, so as to provide practical references for perinatal and neonatal intensive care.
Methods:
Based on the "6S" evidence pyramid model, we searched multiple databases and resources. Evidence was searched in clinical decision support resources, guideline repositories, evidence-based databases, and major English and Chinese literature databases, including British Medical Journal (BMJ), UpToDate, National Institute for Health and Care Excellence (NICE), Guidelines International Network (GIN), Medlive, American Heart Association (AHA), American Academy of Pediatrics (AAP), Joanna Briggs Institute databases (JBI), Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Web of Science, SinoMed, Wanfang Data, and China National Knowledge Infrastructure (CNKI). The search timeframe was from January 2015 to December 2025. Eligible publications included clinical decisions, guidelines, systematic reviews, evidence summaries, expert consensus documents, best practice implementation projects, and randomized controlled trials (RCTs). We extracted evidence from the included literature, summarized and graded it into evidence summaries.
Results:
A total of 20 publications were included, comprising 2 clinical decision resources, 4 guidelines, 6 systematic reviews, 2 evidence summaries, 2 expert consensus documents, 1 best practice implementation report, and 3 RCTs. A total of 46 pieces of best evidence were synthesized and categorized into ten domains: prevention principles, risk factor identification, antenatal preparation, immediate intrapartum and postnatal management, thermoregulation, oxygen therapy support, blood pressure monitoring and assessment, glycemic management, care bundles, and training and education.
Conclusions:
This study synthesizes 46 pieces of best evidence for preventing IVH in preterm infants, providing a robust foundation for clinical practice. However, clinical translation may encounter barriers related to local healthcare policies, equipment constraints, and human resources. When implementing these recommendations, practitioners must carefully evaluate the source context, evidence grading, and institutional adaptability to ensure effective evidence-based practice.
