Could a neonatal care bundle be a promising strategyfor the prevention of intraventricular hemorrhage inpreterm infants? A retrospective cohort study

Background. Germinal matrix-intraventricular hemorrhage (GM-IVH) remains a major cause of morbidity and mortality in preterm infants, particularly in the first days of life. Objectives. The aim of this study was to describe the results of introducing the Neonatal Care Bundle (NCB) in the first 72 hours of life on the incidence of GM-IVH in preterm infants. Methods. A retrospective-observational cohort study of preterm infants with a gestational age <30 weeks and with birthweight <1500 g, before and after the implementation of the protocol, with historical control was conducted. The infants were divided into two groups. Group 1 included infants that received standard neonatal care, and Group 2 included infants that received the NCB. The NCB protocol includes keeping the infant in the midline head position, elevating the head of the incubator to 30°, and avoiding a head lowering position, sudden raising of the legs, or sudden position changes for the first 72 hours. Results. In total, 186 preterm infants were enrolled. The frequency of any grade of GM-IVH and severe IVH were statistically significantly lower in NCB group (p <0.05). In the subgroup analyses of the patients according to birth weight, the rate of GM-IVH was seen to decrease from 41% to 24% in preterm infants <1000 g after NCB. Conclusion. This study adds to the limited literature suggesting that rates of GM-IVH may decrease with increased awareness, standardization, and careful neonatal care during the first 72 hours, the period when preterm infants are at the highest risk.