2021 Annual Conference

CNS Improving Outcomes

Severe intraventricular hemorrhage (IVH) remains a major cause of death and a key indicator of a premature infant's short term and long term neurodevelopmental outcomes.  Annually, over 3600 new cases of severe IVH are reported with estimated costs of $53,600 per infant during initial hospitalization, and a lifetime care cost exceeding 3.6 Billion dollars. By utilizing an interdisciplinary care bundle to minimize the caregiver-imposed stress that increases a neonate’s risk for developing severe intraventricular hemorrhage (IVH), clinical staff in a level III NICU reduced the incidence of severe (grade 3 & 4) IVH in infants born at less than 30 weeks gestation by 71% in the first year following bundle implementation with an estimated cost savings of $643,200.  Grade 1 & 2 IVH rates were reduced by 13.9% in that same year.  Adoption of the IVH prevention care bundle and ongoing monitoring of staff compliance has contributed to sustained gains in IVH reduction for 5 years after bundle implementation and provided a pathway for permanent practice change.  Ongoing review of neonatal outcome data reported to the California Perinatal Quality Care Collaborative (CPQCC) has allowed clinicians to identify a distinct trend of severe IVH occurrence in severe intrauterine growth restricted infants (IUGR) greater than 30 weeks gestation.  The identification of this IVH occurrence trends, supported further refinement of the IVH care bundle to include birthweight quartiles and severe IUGR as criteria for inclusion in the IVH care bundle.