Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Neonatal Intra-Ventricular-Hemorrhage Prevention in Premature at < 30 Weeks Gestational Age

Version 1 : Received: 13 December 2021 / Approved: 15 December 2021 / Online: 15 December 2021 (15:05:46 CET)

How to cite: Hoyos, A.; Vasquez-Hoyos, P. Neonatal Intra-Ventricular-Hemorrhage Prevention in Premature at < 30 Weeks Gestational Age. Preprints 2021, 2021120258 (doi: 10.20944/preprints202112.0258.v1). Hoyos, A.; Vasquez-Hoyos, P. Neonatal Intra-Ventricular-Hemorrhage Prevention in Premature at < 30 Weeks Gestational Age. Preprints 2021, 2021120258 (doi: 10.20944/preprints202112.0258.v1).

Abstract

Introduction: Intraventricular Hemorrhage (IVH) is a devastating condition mostly in preterm infants at < 30 weeks GA with large morbidities and mortality usually in the first 72 hours after birth. Prevention seems to be the only way to completely deal with this problem. The IVH prevention in this age group has been studied and includes some strategies such as prenatal corticosteroids, cesarean delivery, careful extraction among others, but still, it has an unacceptably high incidence in this population.Objective: To measure the application of a quality improvement project develop from the "Drive to Zero IVH Prevention Project" presented in a Epiclatino lecture in our unit.Material and method: We design a before and after observational study and measured the incidence of IVH before and after October 2017 when a minimum manipulation protocol was implemented at the Clínica del Country (CDC) unit. We also compare these findings to those of other units in the EpicLatino network. All patients born <30 weeks GA with less than 2 days of age, who survived at least 3 days, and had a neuroimaging taken were included. We compared demographics, diagnosis, and frequency of IVH cases, before Nov 2017 and after from CDC and the from 2018-2019 EpicLatino registry using a bivariate analysis. Results: We collected data from 46 cases before, 40 after implementation, and 203 cases from the EpicLatino registry. Demographic characteristics were very similar in the post-intervention with few statistically significant differences in antenatal steroid use (97.5% post, 96% before and 79.3% Epilatino, p=0.016), prolonged rupture of membranes (15% post, 4% before and 15% EpicLatino, p <0.001), vaginal deliveries (7.5% post, 10.9% before and 24.1% Epilatino, p=0.01), suspended chorioamnionitis (12.5% post, 6% before and 20.2% Epiclatino). We found a significant reduction in IVH after the protocol was implemented with only 5 (7.5%) cases post-intervention compared to 19 (29.4%) case before, and when compared to the 81 (39.1%) cases in the registry, p< 0.001. Most of the cases that occurred in the post-intervention occurred before admission to the unit due to obstetric trauma.Discussion: If a well-controlled delivery minimizing obstetric trauma is achieved, a minimal manipulation protocol appears to significantly decrease the incidence of HIV. Controlled, multicenter studies are still required to confirm these findings.

Keywords

Intraventricular Hemorrhage; Very preterm infants; Epiclatino registry; Obstetric trauma; Minimal manipulation protocol.

Subject

MEDICINE & PHARMACOLOGY, Pediatrics

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