Effectiveness of a care bundle for primary prevention of intraventricular hemorrhage in high-risk neonates: a Bayesian analysis

• Published in: Journal of perinatology Vol. 43; no. 6; pp. 722 - 727
• Main Authors: al-Haddad, Benjamin J. S., Bergam, Brittany, Johnson, Alicia, Kolnik, Sarah, Thompson, Taylor, Perez, Krystle M., Kennedy, Jacob, Enquobahrie, Daniel A., Juul, Sandra E., German, Kendell
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01.06.2023; Nature Publishing Group
• Subjects: 692/308/409; 692/699/375/2764; Bayes Theorem; Bayesian analysis; Bias; Birth injuries; Birth weight; Cerebral Hemorrhage - epidemiology; Gestational Age; Hemorrhage; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - epidemiology; Infants; Injury prevention; Medicine; Medicine & Public Health; Neonates; Newborn babies; Patient Care Bundles; Patient positioning; Pediatric Surgery; Pediatrics; Prevention; Primary Prevention; Retrospective Studies; Risk groups; Statistical analysis
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/s41372-022-01545-9

Objective To determine whether an intraventricular hemorrhage (IVH) prevention bundle featuring midline-elevated positioning reduced IVH among high-risk infants. Study design In a retrospective study design, we compared outcomes of infants <1250 grams birth weight or <30 weeks gestation before ( N  = 205) and after ( N  = 360) implementation of an IVH prevention bundle, using Bayesian and frequentist logistic regression to determine whether the intervention decreased any grade IVH. Results In both the Bayesian and frequentist analyses, there was no difference in odds of any grade IVH before and after the implementation of the prevention bundle (OR 0.993; 95% Credible Interval 0.751–1.323 and OR 1.23; 95% Confidence Interval 0.818–1.864 respectively). Bias analyses suggested that these results were robust to bias from potential deaths attributable to IVH. Conclusion In this retrospective analysis, we found no evidence for a protective effect of an IVH prevention bundle on IVH incidence among high-risk neonates at a level IV NICU.