Abstract
Objective: Implementation of a nursing care bundle to decrease the incidence and severity of intraventricular hemorrhage in extremely preterm and low birth weight neonates.|Background: Intraventricular hemorrhage is a complication that can occur in the preterm neonatal population potentially resulting in increased morbidity and mortality, prolonged hospitalization, and increased health care costs. Practice changes are needed to decrease the occurrence of intraventricular hemorrhage. Implementation of an intraventricular hemorrhage prevention care bundle in the Neonatal Intensive Care Unit may decrease the intraventricular hemorrhage occurrence and severity rate in neonates less than 30 weeks gestation.|Methods: This was a quality improvement project where evidence-based practices were placed in an intraventricular hemorrhage prevention care bundle. The interventions were practiced for the first 72 hours of life. One week head ultrasounds results were reviewed for the diagnoses and grading of IVH. The sample included patients born less than 30 weeks gestational age during a 12-week period. The sample was a convenience sample and initiation of the bundle was nurse dependent.|Results: During the 12-week period, 11 patients were born that qualified. No intraventricular hemorrhage was noted on 8 patient’s one-week head ultrasound (73%). One patient was noted to have a grade I intraventricular hemorrhage (9%). Including all 11 patients, IVH diagnosis was present in 27%. A severe IVH diagnosis was present in 18%, however there were no grade IV IVH diagnoses. There was no statistical significance in number of IVH diagnoses (p-value = 0.315) or severity of IVH diagnoses (p-value = 0.288) after implementing the IVH Prevention Bundle.|Conclusion: An intraventricular hemorrhage bundle for neonates born at less than 30 weeks gestational age has potential to reduce the severity of IVH diagnosis at one week. Although percentage of IVH diagnoses before and after implementation decreased (35% vs 27%, respectively), it was not significantly different (p=0.315). A larger post-implementation sample number would provide a more equal comparison to the pre-implementation sample. Continued use of the IVH Prevention Care bundle is recommended.