The performance of the practices associated with the occurrence of severe intraventricular hemorrhage in the very premature infants: data analysis from the Chinese neonatal network
Authors: Xiao Tiantian , Hu Liyuan , Chen Huiyao , Gu Xinyue , Zhou Jianguo , Zhu Yanping , Lei Xiaoping , Jiang Siyuan , Lu Yulan , Dong Xinran , Du Lizhong , Lee Shoo K. , Ju Rong , Zhou Wenhao ,   for the Chinese Neonatal Network, Yuan Lin , Yang Tongling , Yuan Hao , Wang Li , Chen Chao , Cao Yun , Chen Xiuyong , Zhang Huyan , Tian Xiuying , Shi Jingyun , Li Zhankui , Yang Chuanzhong , Liu Ling , Yang Zuming , Fu Jianhua , Ji Yong , Chen Dongmei , Yang Changyi , Chen Rui , Peng Xiaoming , Shan Ruobing , Han Shuping , Wu Hui , Wang Lili , Wei Qiufen , Li Mingxia , Dai Yiheng , Jiang Hong , Kang Wenqing , Gong Xiaohui , Zhong Xiaoyun , Shi Yuan , Jiang Shanyu , Sun Bing , Li Long , Lin Zhenlang , Liu Jiangqin , Pan Jiahua , Xia Hongping , Li Xiaoying , Xu Falin , Qiu Yinping , Ma Li , Yang Ling , He Xiaori , Li Yanhong , Zhuang Deyi , Zhang Qin , Dong Wenbin , Sun Jianhua , Liang Kun , Wang Huaiyan , Feng Jinxing , Chen Liping , Lin Xinzhu , Jiang Chunming , Nie Chuan , Zeng Linkong , Hei Mingyan , Zhu Hongdan , Mi Hongying , Yin Zhaoqing , Song Hongxia , Wang Hongyun , Li Dong , Gao Yan , Wang Yajuan , Dai Liying , Zhang Liyan , Li Yangfang , Zhang Qianshen , Ding Guofang , Wang Jimei , Chen Xiaoxia , Wang Zhen , Tang Zheng , Ma Xiaolu , Zhang Xiaomei , Zhang Xiaolan , Wu Fang , Chen Yanxiang , Wu Ying 
Published: June 2024

Abstract
Background
The occurrence of severe intraventricular hemorrhage (sIVH) was high in the very preterm infants (VPIs) in China. The management strategies significantly contributed to the occurrence of sIVH in VPIs. However, the status of the perinatal strategies associated with sIVH for VPIs was rarely described across the multiple neonatal intensive care units (NICUs) in China. We aim to investigate the characteristics of the perinatal strategies associated with sIVH for VPIs across the multiple NICUs in China.

Methods
This was a retrospective analysis of data from a prospective cohort of Chinese Neonatal Network (CHNN) dataset, enrolling infants born at 24+0—31+6 from 2019 to 2021. Eleven perinatal practices performed within the first 3 days of life were investigated including antenatal corticosteroids use, antenatal magnesium sulphate therapy, intubation at birth, placental transfusion, need for advanced resuscitation, initial inhaled gas of 100% FiO2 in delivery room, initial invasive respiratory support, surfactant and caffeine administration, early enteral feeding, and inotropes use. The performances of these practices across the multiple NICUs were investigated using the standard deviations of differences between expected probabilities and observations. The occurrence of sIVH were compared among the NICUs.

Results
A total of 24,226 infants from 55 NICUs with a mean (SD) gestational age of 29.5 (1.76) and mean (SD) birthweight of 1.31(0.32) were included. sIVH was detected in 5.1% of VPIs. The rate of the antenatal corticosteroids, MgSO4 therapy, and caffeine was 80.0%, 56.4%, and 31.5%, respectively. We observed significant relationships between sIVH and intubation at birth (AOR 1.52, 95% CI 1.13 to 1.75) and initial invasive respiratory support (AOR 2.47, 95% CI 2.15 to 2.83). The lower occurrence of sIVH (4.8%) was observed corresponding with the highest utility of standard antenatal care, the lowest utility of invasive practices, and early enteral feeding administration.

Conclusions
The current evidence-based practices were not performed in each VPI as expected among the studied Chinese NICUs. The higher utility of the invasive practices could be related to the occurrence of sIVH.