Neuroprotection Care Bundle Implementation to Decrease Acute Brain Injury in Preterm Infants

Prashanth Murthy; Hussein Zein; Sumesh Thomas; James N Scott; Ayman Abou Mehrem; Michael J Esser; Abhay Lodha; Cathy Metcalfe; Derek Kowal; Leigh Irvine; Jillian Scotland; Lara Leijser; Khorshid Mohammad

doi:10.1016/j.pediatrneurol.2020.04.016

Neuroprotection Care Bundle Implementation to Decrease Acute Brain Injury in Preterm Infants

Pediatr Neurol. 2020 Sep:110:42-48. doi: 10.1016/j.pediatrneurol.2020.04.016. Epub 2020 May 1.

Affiliations

¹ Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
² Division of Neuroradiology, Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada.
³ Section of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada. Electronic address: Khorshid.mohammad@ahs.ca.

PMID: 32473764
DOI: 10.1016/j.pediatrneurol.2020.04.016

Abstract

Background: We assessed the impact of an evidence-based neuroprotection care bundle on the risk of brain injury in extremely preterm infants.

Methods: We implemented a neuroprotection care bundle consisting of a combination of neuroprotection interventions such as minimal handling, midline head position, deferred cord clamping, and protocolization of hemodynamic and respiratory managements. These interventions targeted risk factors for acute brain injury in extremely preterm infants (born at gestational age less than 29 weeks) during the first three days of birth. Implementation occurred in a stepwise manner, including care bundle development by a multidisciplinary care team based on previous evidence and experience, standardization of outcome assessment tools, and education. We compared the incidence of the composite outcome of acute preterm brain injury or death preimplementation and postimplementation.

Results: Neuroprotection care bundle implementation associated with a significant reduction in acute brain injury risk factors such as the use of inotropes (24% before, 7% after, P value < 0.001) and fluid boluses (37% before, 19% after, P value < 0.001), pneumothorax (5% before, 2% after, P value = 0.002), and opioid use (19% before, 7% after, P value < 0.001). Adjusting for confounding factors, the neuroprotection care bundle significantly reduced death or severe brain injury (adjusted odds ratio, 0.34; 95% confidence interval, 0.20 to 0.59; P value < 0.001) and severe brain injury (adjusted odds ratio, 0.31; 95% confidence interval, 0.17 to 0.58; P < 0.001).

Conclusions: Implementation of neuroprotection care bundle targeting predefined risk factors is feasible and effective in reducing acute brain injury in extremely preterm infants.

Keywords: Brain injury; Extreme prematurity; Germinal matrix hemorrhage; Intraventricular hemorrhage; Neuroprotection; Posthemorrhagic ventricular dilatation; Quality improvement.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Brain Injuries / prevention & control*
Evidence-Based Medicine* / methods
Evidence-Based Medicine* / standards
Female
Humans
Infant, Extremely Premature*
Infant, Newborn
Infant, Premature, Diseases / prevention & control*
Intensive Care, Neonatal* / methods
Intensive Care, Neonatal* / standards
Intracranial Hemorrhages / prevention & control*
Male
Outcome and Process Assessment, Health Care*
Patient Care Team
Quality Improvement