Evaluating the Effect of a Neonatal Care Bundle for the Prevention of Intraventricular Hemorrhage in Preterm Infants
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Patients
2.3. Routine Care and Neonatal Care Bundle for the Prevention of IVH
2.4. Neuroimaging
2.5. Study Objectives
2.6. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Patient Positioning |
|
Nursing Care |
|
Care Procedures |
|
Stimulation/Pain Management |
|
Light and Sound Environment |
|
Medical Procedures |
|
Cranial Ultrasound |
|
Review of Practice |
|
Before Implementing the NCB to Prevent IVH (n = 122) | After Implementing the NCB to Prevent IVH (n = 107) | p-Value | |
---|---|---|---|
Gestational age; mean (weeks) | 27.9 ± 2.5 | 27.8 ± 2.8 | 0.67 |
Gestational age; median (weeks) | 28.1 (21.9–32.9) | 28.0 (22.0–36.1) | |
Birth weight; mean (g) | 952.3 ± 268.5 | 907.8 ± 285.6 | 0.23 |
Birth weight; median (g) | 968 (320–1490) | 920 (360–1480) | |
Male | 56/122 (45.9%) | 53/107 (49.5%) | 0.58 |
Small for gestational age | 32/122 (26.2%) | 31/107 (29.0%) | 0.64 |
Multiple births | 42/122 (34.4%) | 39/107 (36.5%) | 0.75 |
Caesarean section | 112/122 (91.8%) | 98/107 (91.6%) | 0.95 |
Chest compression during resuscitation | 1/122 (0.8%) | 1/107 (0.9%) | 0.93 |
Apgar 1; median | 5 (1–9) | 6 (1–10) | 0.47 |
Apgar 5; median | 8 (2–10) | 7 (2–10) | <0.01 |
Apgar 10; median | 9 (0–10) | 8 (2–10) | 0.04 |
pH at birth; median | 7.32 (6.95–7.46) | 7.32 (7.0–7.45) | 0.59 |
Endotracheal intubation within 72 h of life | 53/122 (43.4%) | 61/107 (57.0%) | 0.04 |
Overall intubation rate | 62/122 (50.8%) | 64/107 (59.8%) | 0.17 |
Use of nCPAP during first 72 h of life | 105/122 (86.1%) | 92/107 (85.9%) | 0.99 |
Treatment with Vancomycin/Cefotaxime | 60 (49.2%) | 41 (38.3%) | 0.10 |
Treatment with Vancomycin/Meropenem | 47 (38.5%) | 40 (37.4%) | 0.86 |
NEC ≥ 2 Bell stage | 4/122 (3.3%) | 1/107 (0.9%) | 0.23 |
PVL | 2/122 (1.6%) | 1/107 (0.9%) | 0.64 |
Prophylactic indomethacin for PDA | 18/122 (14.8%) | 2/107 (1.9%) | <0.01 |
Pharmacological PDA treatment | 18/122 (14.8%) | 21/107 (19.6%) | 0.33 |
PDA ligation | 5/122 (4.1%) | 1/107 (0.9%) | 0.14 |
ROP treatment | 10/122 (8.2%) | 6/107 (5.6%) | 0.43 |
Discharge with supplemental oxygen | 11/122 (9.0%) | 13/107 (12.0%) | 0.45 |
Length of NICU stay (days) | 67 (1–164) | 62 (1–160) | 0.15 |
Mortality | 12/122 (9.8%) | 10/107 (9.4%) | 0.90 |
(Additional) risk factors for IVH | |||
No antenatal corticosteroid therapy | 15/122 (12.3%) | 15/107 (14.0%) | 0.47 |
Amnion infection syndrome | 46/122 (37.7%) | 22/107 (20.6%) | <0.01 |
Arterial hypotension | 82/122 (67.2%) | 66/107 (61.7%) | 0.38 |
Use of inotropic agents | 46/122 (37.7%) | 39/107 (36.5%) | 0.84 |
Pneumothorax | 14/122 (11.5%) | 11/107 (10.3%) | 0.79 |
Neonatal transport | 1/122 (0.8%) | 2/107 (1.9%) | 0.49 |
n | IVH Rate | Severe IVH or Death before CUS | Survival | Survival without IVH | ||||||
---|---|---|---|---|---|---|---|---|---|---|
n | Percentage | Percentage | Percentage | Percentage | ||||||
Before | After | Before | After | Before | After | Before | After | Before | After | |
(a) | ||||||||||
<500 g | 10 | 12 | 30.0% | 58.3% | 20.0% | 41.7% | 60.0% | 50.0% | 40.0% | 33.3% |
500–749 g | 20 | 25 | 45.0% | 36.0% | 15.0% | 12.0% | 90.0% | 92.0% | 50.0% | 56.0% |
750–999 g | 41 | 31 | 26.8% | 19.4% | 14.6% | 9.7% | 87.8% | 93.5% | 70.7% | 80.6% |
1000–1249 g | 41 | 31 | 14.6% | 22.6% | 7.3% | 3.2% | 97.6% | 100.0% | 82.9% | 77.4% |
1250–1499 g | 10 | 8 | 30.0% | 0.0% | 10.0% | 0.0% | 100.0% | 100.0% | 70.0% | 100.0% |
<1000 g | 71 | 68 | 32.4% | 32.4% | 15.5% | 16.2% | 84.5% | 85.3% | 60.6% | 63.2% |
<1250 g | 112 | 99 | 25.9% | 29.3% | 12.5% | 12.1% | 89.3% | 89.9% | 68.8% | 67.7% |
<1500 g | 122 | 107 | 26.2% | 27.1% | 12.3% | 11.2% | 90.2% | 90.7% | 68.9% | 70.1% |
(b) | ||||||||||
<24 w | 11 | 8 | 36.4% | 62.5% | 27.3% | 37.5% | 63.6% | 50.0% | 45.5% | 25.0% |
24–25 w | 16 | 18 | 56.3% | 61.1% | 25.0% | 27.8% | 81.3% | 77.8% | 37.5% | 27.8% |
26–27 w | 26 | 27 | 34.6% | 22.2% | 19.2% | 11.1% | 96.2% | 96.3% | 65.4% | 77.8% |
28–29 w | 45 | 31 | 13.3% | 22.6% | 6.7% | 3.2% | 91.1% | 96.8% | 80.0% | 77.4% |
≥30 w | 24 | 23 | 16.7% | 0.0% | 0.0% | 0.0% | 100.0% | 100.0% | 83.3% | 100.0% |
<28 w | 53 | 53 | 41.5% | 41.5% | 22.6% | 20.8% | 84.9% | 83.0% | 52.8% | 52.8% |
<30 w | 98 | 84 | 28.6% | 34.5% | 15.3% | 14.3% | 87.8% | 88.1% | 65.3% | 61.9% |
Total | 122 | 107 | 26.2% | 27.1% | 12.3% | 11.2% | 90.2% | 90.7% | 68.9% | 70.1% |
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Gross, M.; Engel, C.; Trotter, A. Evaluating the Effect of a Neonatal Care Bundle for the Prevention of Intraventricular Hemorrhage in Preterm Infants. Children 2021, 8, 257. https://doi.org/10.3390/children8040257
Gross M, Engel C, Trotter A. Evaluating the Effect of a Neonatal Care Bundle for the Prevention of Intraventricular Hemorrhage in Preterm Infants. Children. 2021; 8(4):257. https://doi.org/10.3390/children8040257
Chicago/Turabian StyleGross, Maximilian, Corinna Engel, and Andreas Trotter. 2021. "Evaluating the Effect of a Neonatal Care Bundle for the Prevention of Intraventricular Hemorrhage in Preterm Infants" Children 8, no. 4: 257. https://doi.org/10.3390/children8040257