Abstract
Purpose: The purpose of this project was to implement and evaluate a nursing care bundle aimed at the prevention of intraventricular hemorrhage in infants born at less than 28 weeks of gestation.|Background: Intraventricular hemorrhage (IVH) is a serious complication of prematurity with potentially devastating effects. These effects are seen in the neonatal period but also have potentially lifelong consequences. IVH rates have continued to remain the same over time, with approximately 20-25% of infants born at less than 1500 grams at birth and 45% of those born at less than 1000 grams developing an IVH.|Sample/Setting: The project was completed at a 54 bed Level III NICU in the Midwest. Thirty-three infants born at less than 28 weeks of gestation prior to project implementation and eighteen infants less than 28 weeks after implementation were included in the evaluation.|Methods: This project was a retrospective chart review. Bundle interventions included strict midline head positioning with an elevated head of bed, no routine daily weights, consistent positioning techniques, measures to decrease noxious stimuli, and no skin-to-skin holding. The incidence and severity of IVH were compared for the eight months prior to and eight months following implementation of the project.|Results: During pre-implementation, 52% of infants were male, 42% were products of multiple gestation, and more than half were born at 26 weeks of gestation or greater. Post-implementation, 56% of infants were male, 61% were products of multiple gestation, and 61% were born at less than 26 weeks of gestation. During pre-implementation, eight out of 33 infants were diagnosed with IVH for an incidence of 24%. Of those diagnosed with IVH, four were classified as mild (grades I and II), two were classified as severe (grades III and IV), and two showed hemorrhage but were non-specific. Post-implementation, seven out of 18 infants were diagnosed with IVH for an incidence of 39%. Of those diagnosed, four were classified as mild, two were classified as severe, and one showed hemorrhage but was non-specific. While IVH incidence was higher in the pre-implementation group, additional analysis found that there was a higher incidence of male sex, multiple gestation, and a smaller average gestational age in the post-implementation group which are all factors that place an infant at higher risk of IVH.|Conclusion: An intraventricular hemorrhage prevention bundle has the potential to decrease IVH rates for infants born at less than 28 weeks of gestation. Although a decrease in IVH rates were not seen in this project, further investigation into project compliance and other contributing factors may further support the use of these interventions.