Abstract
Background: Infants born prior to 30 weeks of gestation are at an increased risk of multiple morbidities and even mortality. Infants’ response to stress and overstimulation can increase the risk of them developing intraventricular hemorrhage (IVH). Neuroprotective care was being performed only about 50% of the time during routine nursing care for infants born prior to 30 weeks of gestation and within the first 72 hours of life. |Purpose: The purpose of this project was to decrease the rate of intraventricular hemorrhages in the extremely and very low birth weight (VLBW) infants and increase the rate of neuroprotective care being provided to these VLBW infants.|Sample/Setting: This QI project took place in an urban NICU in Denver, Colorado. It is a Level III NICU with approximately 600 admission and approximately 15% to 20% of admissions are VLBW infants. All infants that are born under 30 weeks of gestation and under 1500 grams were included in the QI project. |Methods: Education was provided for all staff including bedside nurses, neonatal nurse practitioners, neonatologists, respiratory therapist, and occupational therapists to be familiar with the signs of overstimulation and/or stress and interventions that can assist the infant to alleviate the stress or stressors. Education was provided via poster and one-to-one education. |Results: After education was completed with staff, observational audits showed that almost 93% of the time the staff was responding appropriately to the infants stress cues during routine nursing care. The observational audits also showed that approximately 90% of the time infants received at least one full minute of “hand hugging” prior to routine nursing care to assist the infant’s adaptation to being touched. Results showed that only 10% of the infants had developed IVH during the first week of life. Further cranial ultrasounds will be performed when the infant is corrected to 36 weeks of gestation. |Conclusion: The initial results are encouraging that providing neuroprotective care for these infants may decrease their rates of IVH. Future QI projects can look at infants born even younger and smaller than the infants that were included in this project.