Reducing intraventricular hemorrhage in preterm babies less than 30 weeks of gestation in neonatal intensive care unit, level III: A bundle of care

Intraventricular hemorrhage (IVH) is bleeding into the brain's ventricular system or around the ventricles. The etiology of IVH is multifactorial and is primarily attributed to the fragility of the germinal matrix vasculature and disturbance of cerebral blood flow. IVH is rarely present at birth. Infants born before the 30th week of gestation and weighting <1500 g at birth are at risk for this type of bleeding. The smaller and more premature, unstable infants are at the highest risk for IVH. It occurs more often in the first several days of life. This situation creates immense burden and dilemma for health-care providers mainly when challenged by family choice to withdraw support or do-not-resuscitate incompatible with country law. Purpose: To reduce the overall incidence of IVH to <10% among preterm babies born <30 weeks of gestation using a neuro bundle of care. Methodology: A quality descriptive improved project was conducted in one government sector hospital in Abu Dhabi, Level III neonatal intensive care unit. It was a retrospective study where the data were collected from 2018 to 2019. A multidisciplinary team was formed to implement the neurobundle. Descriptive statistics were used to describe the demographic and clinical finding of the project. Results: Five out of 32 infants and 1 out of 17 infants developed IVH (Grade IV), respectively, in 2018 and 2019. Conclusion: The IVH rate in premature neonates has reduced drastically from 19% (preintervention) to 6% (postintervention) due to implementation IVH bundle and staff compliance.