Impact of a “Brain Protection Bundle” in Reducing Severe Intraventricular Hemorrhage in Preterm Infants <30 Weeks GA: A Retrospective Single Centre Study

Background: despite advances in perinatal care, periventricular/intraventricular hemorrhage (IVH) continues to remain high in neonatal intensive care units (NICUs) worldwide. Studies have demonstrated the benefits of implementing interventions during the antenatal period, stabilization after birth (golden hour management) and postnatally in the first 72 h to reduce the incidence of IVH. Objective: to compare the incidence of severe intraventricular hemorrhage (IVH ≥ Grade III) before and after implementation of a “brain protection bundle” in preterm infants <30 weeks GA. Study design: a pre- and post-implementation retrospective cohort study to compare the incidence of severe IVH following execution of a “brain protection bundle for the first 72 h from 2015 to 2018. Demographics, management practices at birth and in the NICU, cranial ultrasound results and short-term morbidities were compared. Results: a total of 189 and 215 infants were included in the pre- and post-implementation phase, respectively. No difference in the incidence of severe IVH (6.9% vs. 9.8%, p = 0.37) was observed on the first cranial scan performed after 72 h of age. Conclusion: the implementation of a “brain protection bundle” was not effective in reducing the incidence of severe IVH within the first 72 h of life in our centre.

Download Full-text

Serial Cranial Ultrasound Studies in Preterm Infants

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2020.09.11133 ◽

2020 ◽

Vol 103 (9) ◽

pp. 926-930

Keyword(s):

Preterm Infants ◽

Medical Records ◽

Intraventricular Hemorrhage ◽

Neonatal Intensive Care ◽

Cranial Ultrasound ◽

Discrimination Analysis ◽

Ultrasound Studies ◽

Ultrasound Findings ◽

Infant Screening ◽

A Prospective Study

Objective: To study reasonable timing for repeating head ultrasound screenings (HUS) in preterm infants and to find out any change in severity of intraventricular hemorrhage. Materials and Methods: Medical records and ultrasound findings of all preterm infants younger than 32 weeks gestational age (GA) admitted to the neonatal intensive care unit (NICU) at Phramongkutklao Hospital between January 1, 2014 and December 31, 2018 were reviewed retrospectively. Results: One hundred thirty-three infants were included in the present study. Eighty-five infants had at least two HUS and included in discrimination analysis. The positive predictive value for having a normal HUS after two previously normal studies seven or more days apart was 89.30% with a specificity of 80%. Of the 24 preterm infants with IVH, 19 had repeated the cranial ultrasound. This revealed that repeating HUS early (day 7 or earlier), 90% (9/10 infants) found no change in finding, whereas repeating HUS at day 30 or later revealed as high as 76.4% change in findings. Conclusion: Routine screening of cranial ultrasound examinations are recommended for all infants born before 32 weeks GA. If the scan is abnormal, repeating the scan at day 30 or later may be more helpful than as early as day 7. However, if the scan showed no abnormality and had been repeated seven or fewer days apart with the same negative result, subsequent scan may not add benefits. However, these findings need to be proved and may be used only as a guide to design a prospective study in the future. Keywords: Preterm infant, Screening cranial ultrasound, Intraventricular hemorrhage

Download Full-text

The value of autopsy in preterm infants at a Swedish tertiary neonatal intensive care unit 2002–2018

Scientific Reports ◽

10.1038/s41598-021-93358-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Alice Hoffsten ◽

Laszlo Markasz ◽

Katharina Ericson ◽

Leif D. Nelin ◽

Richard Sindelar

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Causes Of Death ◽

Perinatal Care ◽

Clinical Findings ◽

Period 2 ◽

Centralized Care

AbstractReliable data on causes of death (COD) in preterm infants are needed to assess perinatal care and current clinical guidelines. In this retrospective observational analysis of all deceased preterm infants born < 37 weeks’ gestational age (n = 278) at a Swedish tertiary neonatal intensive care unit, we compared preliminary COD from Medical Death Certificates with autopsy defined COD (2002–2018), and assessed changes in COD between two periods (period 1:2002–2009 vs. period 2:2011–2018; 2010 excluded due to centralized care and seasonal variation in COD). Autopsy was performed in 73% of all cases and was more than twice as high compared to national infant autopsy rates (33%). Autopsy revised or confirmed a suspected preliminary COD in 34.9% of the cases (23.6% and 11.3%, respectively). Necrotizing enterocolitis (NEC) as COD increased between Period 1 and 2 (5% vs. 26%). The autopsy rate did not change between the two study periods (75% vs. 71%). We conclude that autopsy determined the final COD in a third of cases, while the incidence of NEC as COD increased markedly during the study period. Since there is a high risk to determine COD incorrectly based on clinical findings in preterm infants, autopsy remains a valuable method to obtain reliable COD.

Download Full-text

The Effect of the Transfusion Protocol on Transfusion Rates and Short-term Outcomes of Preterm Infants in a Tertiary Neonatal Intensive Care Unit

Iranian Journal of Pediatric Hematology & Oncology ◽

10.18502/ijpho.v11i4.7170 ◽

2021 ◽

Author(s):

Emel Okulu ◽

Yasemin Ezgi Kostekci ◽

Elvis Kraja ◽

Omer Erdeve ◽

Saadet Arsan ◽

...

Keyword(s):

Preterm Infants ◽

Neonatal Intensive Care ◽

Inverse Relationship ◽

Short Term ◽

Total Blood ◽

Period 2 ◽

Before And After ◽

Transfusion Guidelines ◽

Transfusion Protocol ◽

Rbc Transfusion

Background: The aim of this study was to compare the epochs before and after the revision of the transfusion guideline, and determine their effects on transfusion rates and short-term outcomes in preterm infants. Materials and Methods: This retrospective study was conducted to investigate the effect of the new transfusion guideline. Infants who were born <32 weeks of gestation and received red blood cell (RBC) transfusion in their first 6-weeks of life were divided into two epochs according to adopting the new transfusion guideline. The demographic and clinical data of the patients were compared between these two periods. Results: Fifty-six infants were included (Period 1, n=22; Period, n=34). The number of transfusions, total and cumulative volume of the transfusions were similar in the two periods. There was an inverse relationship between the gestational age and the number of transfusions in both periods (r=-0.575, p=0.005, and r=-0.494, p=0.003), and there was an inverse relationship between the birth weight and the number of transfusions in period 2 (r=-0.423, p=0.013). The ratio of total phlebotomy volume to estimated total blood volume was higher in period 2 (p=0.029). There was a direct relationship between the phlebotomy loss and volume of RBC transfused in period 2 (r=0.487, p=0.003). The incidence of morbidities was similar in the two periods. Conclusion: Changing only the transfusion protocol did not decrease the transfusion number. Although transfusion guidelines were adopted rigorously, it seems to be impossible to reduce RBC transfusion rates unless anemia prevention strategies were also in place.

Download Full-text

Early Vital Sign Differences in Very Low Birth Weight Infants with Severe Intraventricular Hemorrhage

American Journal of Perinatology ◽

10.1055/s-0041-1733955 ◽

2021 ◽

Author(s):

Santina A. Zanelli ◽

Maryam Abubakar ◽

Robert Andris ◽

Kavita Patwardhan ◽

Karen D. Fairchild ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Vital Sign ◽

Intraventricular Hemorrhage ◽

Neonatal Intensive Care ◽

Very Low Birth Weight ◽

Cranial Ultrasound ◽

Low Birth Weight Infants ◽

Vlbw Infants ◽

Arterial Blood

Objective Severe intraventricular hemorrhage (sIVH, grades 3 and 4) is a serious complication for very low birth weight (VLBW) infants and is often clinically silent requiring screening cranial ultrasound (cUS) for detection. Abnormal vital sign (VS) patterns might serve as biomarkers to identify risk or occurrence of sIVH. Study Design This retrospective study was conducted in VLBW infants admitted to two level-IV neonatal intensive care units (NICUs) between January 2009 and December 2018. Inclusion criteria were: birth weight <1.5 kg and gestational age (GA) <32 weeks, at least 12 hours of systemic oxygen saturation from pulse oximetry (SpO2) data over the first 24 hours and cUS imaging. Infants were categorized as early sIVH (sIVH identified in the first 48 hours), late sIVH (sIVH identified after 48 hours and normal imaging in the first 48 hours), and no IVH. Infants with grades 1 and 2 or unknown timing IVH were excluded. Mean heart rate (HR), SpO2, mean arterial blood pressure (MABP), number of episodes of bradycardia (HR < 100 bpm), and desaturation (SpO2 < 80%) were compared. Results A total of 639 infants (mean: 27 weeks' gestation) were included (567 no IVH, 34 early sIVH, and 37 late sIVH). In the first 48 hours, those with sIVH had significantly higher HR compared with those with no IVH. Infants with sIVH also had lower mean SpO2 and MABP and more desaturations <80%. No significant differences in VS patterns were identified in early versus late sIVH. Logistic regression identified higher HR and greater number of desaturations <80% as independently associated with sIVH. Conclusion VLBW infants who develop sIVH demonstrate VS differences with significantly lower SpO2 and higher mean HR over the first 48 hours after birth compared with VLBW infants with no IVH. Abnormalities in early VS patterns may be a useful biomarker for sIVH. Whether VS abnormalities predict or simply reflect sIVH remains to be determined. Key Points

Download Full-text

Assessing key clinical parameters before and after intraventricular hemorrhage in very preterm infants

European Journal of Pediatrics ◽

10.1007/s00431-020-03585-9 ◽

2020 ◽

Vol 179 (6) ◽

pp. 929-937 ◽

Cited By ~ 1

Author(s):

Renée Lampe ◽

Esther Rieger-Fackeldey ◽

Irina Sidorenko ◽

Varvara Turova ◽

Nikolai Botkin ◽

...

Keyword(s):

Preterm Infants ◽

Intraventricular Hemorrhage ◽

Clinical Parameters ◽

Very Preterm Infants ◽

Very Preterm ◽

Before And After

Download Full-text

Association of Resident Duty Hour Reform and Neonatal Outcomes of Very Preterm Infants

American Journal of Perinatology ◽

10.1055/s-0037-1603687 ◽

2017 ◽

Vol 34 (14) ◽

pp. 1396-1404

Author(s):

Bruno Piedboeuf ◽

Robert Platt ◽

Keith Barrington ◽

Victoria Bizgu ◽

Prakesh Shah ◽

...

Keyword(s):

Preterm Infants ◽

Neonatal Intensive Care ◽

Neonatal Outcomes ◽

Neonatal Intensive Care Units ◽

Composite Outcome ◽

Major Morbidity ◽

Very Preterm Infants ◽

Very Preterm ◽

Before And After ◽

Resident Duty

Objective To assess the association of the 2011 Quebec provincial resident duty hour reform, which reduced the maximum consecutive hours worked by all residents from 24 to 16 hours, with neonatal outcomes. Study Design Retrospective observational study of 4,271 infants born between 23 and 32 weeks, admitted at five Quebec neonatal intensive care units (NICUs) participating in the Canadian Neonatal Network (CNN) between 2008 and 2015 was conducted. Adjusted odds ratios (AORs) were calculated to compare mortality and the composite outcome of mortality or major morbidity before and after the implementation of the duty hour reform. Results The mortality rate was 8.4% (218/2,598) before the resident duty hour reform and 8.6% (182/2,123) after the reform (odds ratio [OR] = 1.02, 95% confidence interval [CI] = 0.83–1.26). The composite outcome rate was 32% (830/2,598) before the duty hour reform and 29% (615/2,123) after the reform (OR = 0.87, 95% CI = 0.77–0.98). In the adjusted analyses, the resident call-hour reform was not associated with a significant change in mortality (AOR = 1.17, 95% CI = 0.91–1.50) or composite outcome (AOR = 0.87, 95% CI = 0.74–1.03). Conclusion Reducing residents' duty hours from 24 to 16 hours in Quebec was not associated with a difference in mortality or the composite outcome of very preterm infants.

Download Full-text

Nitric Oxide and Bleeding Time

PEDIATRICS ◽

10.1542/peds.94.1.134b ◽

1994 ◽

Vol 94 (1) ◽

pp. 134-135

Author(s):

Benjamin Gaston ◽

Julian F. Keith

Keyword(s):

Nitric Oxide ◽

Intensive Care Unit ◽

Intensive Care ◽

Acute Lung Injury ◽

Side Effects ◽

Lung Injury ◽

Preterm Infants ◽

Intraventricular Hemorrhage ◽

Neonatal Intensive Care ◽

Bleeding Time

Abman, Kinsella, and co-workers caution against the widespread use of nitric oxide (NO) gas in the neonatal intensive care unit.1,2 However, like other leading advocates of NO therapy, they limit their remarks concerning toxicology to a discussion of the risks of acute lung injury and methemoglobinemia. It must be remembered that NO may have other important side effects as well. In particular, NO inhalation in concentrations of 30 ppm prolongs bleeding time in rabbits and humans,3 making it a uniquely dangerous agent for use in preterm infants at risk for intraventricular hemorrhage.

Download Full-text

Evaluating the Effect of a Neonatal Care Bundle for the Prevention of Intraventricular Hemorrhage in Preterm Infants

Children ◽

10.3390/children8040257 ◽

2021 ◽

Vol 8 (4) ◽

pp. 257

Author(s):

Maximilian Gross ◽

Corinna Engel ◽

Andreas Trotter

Keyword(s):

Risk Factors ◽

Preterm Infants ◽

Nursing Care ◽

Intraventricular Hemorrhage ◽

Neonatal Intensive Care ◽

Patient Positioning ◽

Neonatal Care ◽

Care Bundle ◽

Early Intubation ◽

Increased Risk

Germinal matrix intraventricular hemorrhage (IVH) remains a severe and common complication in preterm infants. A neonatal care bundle (NCB) was implemented as an in-house guideline at a tertiary neonatal intensive care unit to reduce the incidence of IVH in preterm infants. The NCB was applied either to preterm infants <1250 g birth weight or <30 weeks gestational age or both, and standardized patient positioning, nursing care, and medical procedures within the first week of life. A retrospective cohort study was performed to investigate the effect of the NCB and other known risk factors on the occurrence and severity of IVH. Data from 229 preterm infants were analyzed. The rate of IVH was 26.2% before and 27.1% after implementing the NCB. The NCB was associated neither with reducing the overall rate of IVH (odds ratio (OR) 1.02; 95% confidence interval (CI) 0.57–1.84; p = 0.94) nor with severe IVH (OR 1.0; 95% CI 0.67–1.55; p = 0.92). After adjustment for group differences and other influencing factors, amnion infection syndrome and early intubation were associated with an increased risk for IVH. An NCB focusing on patient positioning, nursing care, and medical interventions had no impact on IVH in preterm infants. Known risk factors for IVH were confirmed.

Download Full-text

Clinical Predictability of Intraventricular Hemorrhage in Preterm Infants

PEDIATRICS ◽

10.1542/peds.65.1.30 ◽

1980 ◽

Vol 65 (1) ◽

pp. 30-34

Author(s):

Anthony Lazzara ◽

Peter Ahmann ◽

Francine Dykes ◽

Alfred W. Brann ◽

James Schwartz

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intracerebral Hemorrhage ◽

Ct Scan ◽

Preterm Infants ◽

Blood Cells ◽

Intraventricular Hemorrhage ◽

Neonatal Intensive Care ◽

Clinical Signs ◽

Packed Red Blood Cells

Ninety-eight infants of less than 35 weeks' gestation, consecutively admitted to a regional neonatal intensive care unit, were followed prior to computerized tomography (CT) scan for clinical signs of subependymal and/or intraventricular hemorrhage. The presence or absence of intracerebral hemorrhage was confirmed by CT scan in all patients, and the severity of hemorrhage was quantitated as mild, moderate, or marked. Thirty-seven out of 98 infants (38%) demonstrated intracerebral hemorrhage on CT scan; 20 of 37 (54%) were predicted clinically. Clinical predictability was related to severity of hemorrhage as quantitated by CT scan. Clinical signs that were found helpful in predicting subependymal and/ or intraventricular hemorrhage were fall in hematocrit, failure of rise in hematocrit with transfusion of packed red blood cells, tight fontanel, decrease in spontaneous activity, decreased tone, abnormal eye signs, and seizures.

Download Full-text

Active perinatal care of preterm infants in the German Neonatal Network

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2018-316770 ◽

2019 ◽

Vol 105 (2) ◽

pp. 190-195 ◽

Cited By ~ 7

Author(s):

Alexander Humberg ◽

Christoph Härtel ◽

Tanja K. Rausch ◽

Guido Stichtenoth ◽

Philipp Jung ◽

...

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Neonatal Intensive Care ◽

Human Subjects ◽

Perinatal Care ◽

Survival Rates ◽

Neonatal Intensive Care Units ◽

Institutional Review ◽

The University ◽

High Percentile

ObjectiveTo determine if survival rates of preterm infants receiving active perinatal care improve over time.DesignThe German Neonatal Network is a cohort study of preterm infants with birth weight <1500 g. All eligible infants receiving active perinatal care are registered. We analysed data of patients discharged between 2011 and 2016.Setting43 German level III neonatal intensive care units (NICUs).Patients8222 preterm infants with a gestational age between 22/0 and 28/6 weeks who received active perinatal care.InterventionsParticipating NICUs were grouped according to their specific survival rate from 2011 to 2013 to high (percentile >P75), intermediate (P25–P75) and low (<P25) survival. We compared these survival rates with data in 2014–2016.Main outcome measuresDeath by any cause before discharge.ResultsTotal survival increased from 85.8% in 2011–2013 to 87.4% in 2014–2016. This increase was due to reduced mortality of NICUs with low survival rates in 2011–2013. Survival increased in these centres from 53% to 64% in the 22–24 weeks strata and from 73% to 84% in the 25–26 weeks strata.ConclusionsOur data support previous reports that active perinatal care of very immature infants improves outcomes at the border of viability and survival rates at higher gestational ages. The high total number of surviving infants below 24 weeks of gestation challenges national recommendations exclusively referring to gestational age as the single criterion for providing active care. However, more data are needed before recommendations for parental counselling should be reconsidered.Trial registrationApproval by the local institutional review board for research in human subjects of the University of Lübeck (file number 08–022) and by the local ethic committees of all participating centres has been given.

Download Full-text