Effectiveness of Nursing Care Bundle for the Prevention of Intraventricular Hemorrhage in Preterm Infants

Study Overview
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Brief Summary
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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
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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.

Official Title
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Effectiveness of Nursing Care Bundle for the Prevention of Intraventricular Hemorrhage in Preterm Infants

Conditions
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Intraventricular Hemorrhage of Prematurity, Nursing Caries

Intervention / Treatment
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* Other: IVH care Bundle


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Inborn Preterm infants Preterm infants with birth weight less than 1,500 g or gestational age ≤30 weeks Exclusion Criteria: Preterm infants with congenital malformations Genetic syndromes Congenital infections of the TORCHS group(syphilis, rubella, herpes, toxoplasmosis, and cytomegalovirus) Resuscitation and Pneumothorax at birth.

Ages Eligible for Study
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Minimum Age: 1 Day
Maximum Age: 1 Month

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Control group<br>The infants will be divided into 200 in the control group. Eligible hospitalized preterm infants that met the inclusion criteria from January 2017 to December 2019 were selected for the control group by retrospective cohort. | |
| Experimental group<br>The infants will be divided into 30 in the experimental group. | Other: IVH care Bundle<br>* 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.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The incidence of intraventricular hemorrhage | Grading of Intraventricular Hemorrhage | 72 postnatal hours | 
| The incidence of intraventricular hemorrhage | Grading of Intraventricular Hemorrhage | 168 postnatal hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The length of stay in the intensive care unit | Inpatient days | From date of admission until the date of leave Neonatal intensive care unit up to 48 weeks | 
| Mortality | neonatal death | From date of admission until the date of death from any cause up to 4 postnatal weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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premature infants, bundle care, Intraventricular hemorrhage (IVH)