Impact of a Structured Brain Care Bundle on Severe Germinal Matrix Hemorrhage-Intraventricular Hemorrhage in Very Preterm Neonates: A Retrospective Cohort Study.

BACKGROUND

Germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) remains a leading cause of neurologic morbidity and mortality in very preterm infants. Evidence supports the assertion that standardized neuroprotective "Brain Care Bundles" (BCBs) can reduce GMH-IVH risk, but data from Middle Eastern Level III neonatal intensive care units are limited.

METHODS

We performed a retrospective cohort study comparing pre-BCBs (January-December 2021; n = 80) versus post-BCB (January-December 2022; n = 77) cohorts of inborn infants ≤30 weeks' gestation and or birth weight ≤1500 g. The ten-component BCBs included antenatal steroids, magnesium sulfate, delayed cord clamping, thermoregulation, midline head positioning, minimal handling, permissive hypercapnia, targeted oxygen saturation, hemodynamic thresholds, and neurodevelopmental support. The primary outcome was rate of severe GMH-IVH (Papile grade III-periventricular hemorrhagic infarction) on cranial ultrasound after 72 hours. Secondary outcomes included any-grade GMH-IVH, post-hemorrhagic hydrocephalus, necrotizing enterocolitis (≥stage 2), late-onset sepsis, bronchopulmonary dysplasia, retinopathy of prematurity (≥stage 3), and mortality.

RESULTS

Baseline demographics were comparable except for a higher male proportion in the pre-BCBs cohort (63.7% vs 44.0%; P = 0.017). Delayed cord clamping and completion of antenatal steroids improved significantly post-BCBs (P < 0.05). Severe GMH-IVH incidence declined from 15% to 5% (AR = 10.2%; P = 0.045); BCBs implementation remained independently protective in multivariable analysis (adjusted odds ratio = 0.52; 95% confidence interval: 0.27-0.99; P = 0.048). Late-onset sepsis decreased markedly (P = 0.002). No significant differences were found in rates of necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity, hydrocephalus, or mortality.

CONCLUSIONS

Implementation of the BCBs in a high-risk Middle Eastern neonatal intensive care unit was associated with significantly reduced severe GMH-IVH and late-onset sepsis, along with better antenatal steroid adherence. These results support adopting neuroprotective BCBs as a quality improvement strategy in vulnerable preterm populations.