P2.H141: Effect of the implementation of a neuroprotection bundle on the incidence and outcomes in premature neonates diagnosed with intraventricular hemorrhage: a single center retrospective review study

Background: Intraventricular hemorrhage (IVH) can bring catastrophic consequences to the already complex medical challenges of premature infants. Despite advances in technology, IVH continues to affect an estimated 20% of preterm births. There are interventions that have shown some promise in decreasing the rates of IVH and can be applied together as part of a “neuroprotection bundle” but results have been inconsistent across studies. Interventions affect antepartum, delivery room and neonatal intensive care unit care. The aim of this study was to evaluate incidence rates before and after implementation of bundle for neonates less than 31 weeks of gestation and analyze demographic and clinical data variables in our institution.

Methods: Institutional Review Board approval was obtained (MHS.2019.038) for retrospective chart review. Patient records were reviewed for incidence of IVH and clinical variables. All analyses were conducted using Stata/SE 15.1.

Results: Records of 366 patients were included in the analysis with 56% (n=204) in the pre-bundle period and 44% (n=162) in the post-bundle period. While there were no statistically significant differences in patient demographics between the two patient cohorts, a significantly higher proportion of patients in the post-bundle period had delayed cord clamping compared to patients in the pre-bundle period (72.8% vs. 46.6%; P < 0.001) which reflects successful implementation of this practice in our institution. There were also no statistically significant differences in the rates of IVH, but there were differences in IVH grades between the pre- and post-bundle periods. Specifically, IVH grade 1 was most prevalent among the post-bundle cohort (47.8%) while IVH grade 2 was most prevalent among the pre-bundle cohort (32.7%) (P=0.047). In line with this, in the assessment of severe IVH rates (i.e., defined as IVH grades 3 or 4), results showed that the rates of severe IVH in the post-bundle cohort were significantly lower than those observed in pre-bundle cohort (9.8% vs. 3.7%; P=0.024). When treatment and clinical outcomes were assessed, there were no statistically significant differences between patients in the pre- and post-bundle periods.

Conclusion: During the study period, introduction of the neuroprotection bundle did not influence overall IVH rates nor treatment and clinical outcomes among neonates at our institution. However, results of our study suggests that the introduction of the neuroprotection bundle had a positive impact on the severity of IVH. Specifically, neonates were less likely to have severe IVH during the post-bundle period of our study. Further studies in IVH prevention strategies are needed to continue to define best practices to protect this vulnerable population.