A recent study on premature babies at East Tennessee Children’s Hospital has delivered nearly 50% reduction in all grades of intraventricular haemorrhage (IVH) and additionally a decrease in the levels of severity1. With the significant impact on outcomes after IVH in infants, the study’s recommendations have the potential to deliver a massive benefit to patients, their families and the long-term cost burden on the healthcare system. The publication also highlighted the barriers to implementation of the new protocols and how they were overcome.
The study’s authors researched the scientific evidence relating to IVH prevention in preterm infants and then formulated and implemented a set of guidelines for their NICU. This not only gave clear protocols for staff to follow, but also helped educate about the anatomy and physiology of a premature baby’s brain and increased awareness of the impact that nursing practices can have.
The research followed patients delivered at less than 32 weeks’ gestation and included 49 infants with gestational ages ranging from 23 to 32 weeks. The occurrence of IVH in this group was compared to data for all VLBW infants treated at the same institution in the previous year, with the study showing IVH rates of 10.9% compared to 21.3% in the control group, a 48.8% reduction.
The guidelines include 15 separate points, most related to environmental factors, thermal management, positioning, handling and interventions. One of the less well-known considerations was maintaining midline (neutral) head positioning, which helps prevent inadvertent jugular vein compression. The use of the Tortle head positioning system facilitates this aspect of the protocol.
- VanArsdale A, Upton F. NICU Nurse Driven IVH Prevention Initiative. East Tennessee Children’s Hospital, Knoxville, TN, USA.