Neuroprotection Care Bundle Implementation to Decrease Acute Brain Injury in Preterm Infants - 20/08/20
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.
Le texte complet de cet article est disponible en PDF.Keywords : Extreme prematurity, Brain injury, Neuroprotection, Quality improvement, Intraventricular hemorrhage, Germinal matrix hemorrhage, Posthemorrhagic ventricular dilatation
Plan
| Conflict of interest and source of funding statement: The authors declare no conflict of interest or financial disclosures concerning the materials or methods used in this study or the findings specified in this article. |
Vol 110
P. 42-48 - septembre 2020 Retour au numéro
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