MSc. Postgraduate Student. Neonatal Division, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo (SP), Brazil.
MD, PhD. Adjunct Professor, Neonatal Division, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo (SP), Brazil.
Sao Paulo Med J. 2021 May 10;139(3):251-258. doi: 10.1590/1516-3180.2020.0412.R1.28012021. eCollection 2021.
Peri/intraventricular hemorrhage (PIVH) is a frequent cause of death and morbidity among preterm infants. Few studies have addressed the use of bundles for preventing PIVH.
To evaluate the efficacy of a bundle of interventions designed to decrease the incidence of intraventricular hemorrhage at hospital discharge among preterm infants.
Pre-post interventional study with retrospective and prospective data collection performed before and after bundle implementation in the neonatal intensive care unit of a university hospital.
Infants with gestational age < 32 weeks without malformations, who survived > 6 days were included. The bundle consisted of the following actions during the first 72 hours of life: maintenance of head in neutral position with the body in supine position, minimal handling, including delay of lumbar puncture until after 72 hours and absence of respiratory therapy maneuvers. Cranial ultrasound was performed on days 3, 7 and 28, or later if needed. The effect of the bundle was analyzed through logistic regression and results were adjusted for confounding variables.
167 infants met the inclusion criteria; 146 (87%) were analyzed. Bundle implementation was associated with decreased chances of PIVH at hospital discharge (odds ratio 0.29; 95% confidence interval 0.13-0.65). Cerebrospinal fluid collection within the first 72 hours increased the odds of PIVH of any grade during the hospital stay fourfold, after adjustment for all variables included in the model.
Implementation of a bundle of interventions to avoid intraventricular hemorrhage was effective for decreasing the incidence of all grades of PIVH in preterm infants.
围生期/脑室内出血（PIVH）是早产儿死亡和发病的常见原因。很少有研究涉及使用套件来预防 PIVH。
评估旨在降低早产儿出院时脑室内出血发生率的干预措施套件的疗效。
在大学医院新生儿重症监护病房，在实施干预措施前后进行回顾性和前瞻性数据收集的前后干预研究。
纳入胎龄<32 周、无畸形且存活>6 天的婴儿。该套件包括以下生命最初 72 小时内的操作：将头部保持在中立位置，身体仰卧，尽量减少处理，包括延迟至 72 小时后进行腰椎穿刺，以及不进行呼吸治疗操作。如果需要，在第 3、7 和 28 天或之后进行头颅超声检查。通过逻辑回归分析套件的效果，并针对混杂变量调整结果。
167 名婴儿符合纳入标准；146 名（87%）进行了分析。实施套件与降低出院时 PIVH 的几率相关（比值比 0.29；95%置信区间 0.13-0.65）。在调整模型中包含的所有变量后，在生命最初 72 小时内进行脑脊液采集会使任何等级的 PIVH 在住院期间发生的几率增加四倍。
实施避免脑室内出血的干预措施套件可有效降低早产儿所有等级 PIVH 的发生率。
