93 - Prevention of Severe Intraventricular Hemorrhage in Infants Born less than 32 weeks in a Level IV NICU

Poster Number: 93
Publication Number: 93.3028

Background: Intraventricular hemorrhage (IVH) occurs when vessels of the germinal matrix in the periventricular area rupture, which can cause bleeding into the ventricles. Severe IVH is defined as hemorrhage with ventricular dilatation or brain parenchyma bleed, and it is associated with undesired neurodevelopmental outcomes. Infants born less than 32 weeks are at risk for IVH. The incidence of severe IVH varies among institutions. Most recently, delayed cord clamping (DCC) and implementation of a comprehensive perinatal care plan have been shown to be beneficial in reducing severe IVH.

Objective: Increase DCC rate at our institution.
Implement a comprehensive perinatal care plan to prevent IVH.
Decrease severe IVH in infants born less than 32 weeks.

Design/Methods: This quality improvement project spanned July 2022 to June 2023. Baseline data was collected on the incidence of IVH and severe IVH in our institution with an annual average of 70 to 80 infants born less than 32 weeks. In the first PDSA cycle, updates were made in the electronic medical record to ensure DCC was documented. Additionally, education was provided to the Obstetric team with an emphasis of a “time out” prior to delivery to discuss the umbilical cord management plan. In the second PDSA cycle, a comprehensive IVH prevention bundle was introduced, which included robust prenatal care (steroids, magnesium use, and treatment of chorioamnionitis), delivery room care (DCC, experienced resuscitation team, and prevention of hypothermia), and postnatal care (implementing multidiscipline developmental rounds to educate bedside nurses, respiratory therapists and parents about comprehensive neurodevelopmental care). This intervention was sustained in PDSA cycles 3 and 4.

Results: There were 77 infants less than 32 weeks born between July 2022 and June 2023. Baseline data on 37 infants born less than 32 weeks from Oct 2021 to March 2022 demonstrated a rate of severe IVH at 10.8% with DCC rates of 30%. After PDSA cycle 2, there was a significant increase in DCC, from 30% to 95%. The DCC rate sustained at 87.5% and 63% in PDSA cycle 3 and 4, respectively. A decrease of severe IVH was observed from 10.8% to 3%, particularly in the 24 to 26 weeks gestational age group. In this group (n=12), the incidence of severe IVH decreased from 20% to 0%.

Conclusion(s): Implementation of a comprehensive perinatal care plan to prevent IVH is feasible and beneficial. Multidisciplinary developmental rounds to decrease severe IVH benefits all team members involved in the care of infants. Sustaining a high rate of DCC contributes to decreased severe IVH at our institution.