Reducing severe intraventricular haemorrhage rates in <26-week preterm infants with bedside assessment and care bundle implementation

Abstract

Aim: To assess staff adherence to a ‘Preterm Brain Injury Prevention Bundle’, and its effectiveness in reducing severe intraventricular haemorrhage (IVH) rates and risk factors in extremely preterm infants born at <26 weeks' gestation. Methods: Adherence to the bundle was assessed using a novel bedside assessment tool, with immediate feedback to bedside staff post-assessment. Data on IVH rates and associated risk factors were stratified by IVH severity, and compared between pre- and post-bundle implementation. Results: Of 203 bedside assessments, good adherence was observed in 12/28 items (43%), while the remaining items required improvement. Rates of grade 3/4 IVH reduced (39.2% pre-bundle vs. 19.0% post-bundle, p = 0.13). Thermoregulation and base excess improved (p = 0.02 and p = 0.04 respectively) after bundle implementation. Conclusion: Reduced severe IVH rates post-bundle implementation may be attributed to staff education and improved clinical parameters. Adherence to the bundle interventions varied which highlighted target areas for future education.