Effectiveness of Nursing Care Bundle for the Prevention of Intraventricular Hemorrhage in Preterm Infants
Condition: Intraventricular Hemorrhage of Prematurity; Nursing Caries
MeSH terms: Cerebral Hemorrhage; Hemorrhage
Study type: Observational

Summary: 
      Existing measures to prevent intraventricular hemorrhage in preterm infants include
      preventing premature delivery, pre-natal administration of corticosteroid, active treatment
      of chorioamnionitis, and improvement of postnatal resuscitation and transfer process. Many
      overseas studies show that nursing care can reduce the risk of intraventricular hemorrhage
      and death, but there is no such study in Taiwan.

      Objective: to explore the effect of bundle nursing care on prevention of IVH in premature
      infants.
    

Detailed description: 
      A quasi-experimental study design was employed and a total of 230 preterm infants with birth
      weight less than 1,500 g or gestational age ≤30 weeks will be recruited at the neonatal
      intensive care unit of National Taiwan University Hospital. The infants will be divided into
      200 in the control group and 30 in the experimental group. Enrollment began after approval
      was granted by the Institutional Review Board. Eligible hospitalized preterm infants that met
      the inclusion criteria from January 2017 to December 2029 were selected for the control group
      by retrospective cohort and matched by the gestational age, birth weight and delivery method
      with the experimental group. The experimental group received bundle nursing care within 3
      days after birth in addition to routine nursing care after consent was given and the informed
      consent form was signed. The study tools include 1. Intervention Tools: small towel or head
      positioning pillow (Tortle Midliner) and timer; 2. Data collection: Self-created
      questionnaire on awareness and behavior for preventing intraventricular hemorrhage in preterm
      infants in nurses, medical record and bundle care implementation record. The data were
      analyzed by descriptive statistics, t-test, Chi-square test and Logistic regression using
      SPSS 26 statistical software. The expected results are reduction in the incidence of
      intraventricular hemorrhage, the length of stay in the intensive care unit and mortality.
    

Intervention name(s): IVH care Bundle
Intervention type(s): Other
Intervention description(s): The experimental group received bundle nursing care within 3 days after birth in addition to routine nursing care after consent was given and the informed consent form was signed.
IVH care Bundle: 1. Maintaining midline head position 2. Avoid prone, place in supine or side-lying position 3. Incubator tilted 15-30 degrees 4. Slow withdrawal and flushing for UAC, UVC, and PAL.
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        Very Low Birth Weight(VLBW) : Preterm infants with birth weight less than 1500g.

        Intraventricular hemorrhage (IVH) is one of the serious complications in preterm infants
        and is present in about 25-30% of VLBW, which is related to long-term neurological sequelae
        and mortality.
      
Keywords: premature infants; bundle care; Intraventricular hemorrhage (IVH)