The Journal of pediatrics · 2026
Neuroprotection Bundles and Intraventricular Hemorrhage Rates in Neonates <29 Weeks' Gestation.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Deshpande Poorva, Goswami Ipsita, Mohammad Khorshid, Ng Eugene, Garfinkle Jarred, Wintermark Pia, Mukerji Amit, Yoon Eugene, Beltempo Marc, Shah Prakesh S, Canadian Neonatal Network and Canadian Preterm Birth Network Investigators
Аннотация
OBJECTIVE: To evaluate the association of intraventricular hemorrhage-neuroprotection bundle (IVH-NB) implementation on intraventricular hemorrhage (IVH) rates in infants born at <29 weeks' gestation.
STUDY DESIGN: This multicenter, retrospective, preimplantation and postimplementation cohort study included neonates of <29 weeks' gestation admitted to Canadian neonatal intensive care units (NICUs) participating in the Canadian Neonatal Network. Sites which implemented IVH-NB were identified via a survey. Data were collected for 36 months each for preimplantation and postimplementation periods per NICU, with 1-month washout. Infants with major anomalies or admitted >2 days after birth were excluded. Primary outcome was a composite of severe IVH (grade III/IV) or death ≤ first 7 days. Secondary outcomes included severe IVH, posthemorrhagic ventricular dilatation, and severe neurological injury (severe IVH or periventricular leukomalacia).
RESULTS: Seventeen NICUs that implemented IVH-NB were included, contributing a total of 6522 infants (3216 preimplementation and 3306 postimplementation). Postimplementation, deferred cord clamping (56% vs 62%, P < .0001), prophylactic indomethacin (15% vs 19%, P < .0001), and normothermia (50% vs 56%, P < .0001) increased, and cardiopulmonary resuscitation (29% vs 25%, P < .0001) and endotracheal intubation at birth decreased (46% vs 41%, P < .0001). After implementation, aOR for the composite outcome (aOR 1.07, 95% CI 0.84, 1.35), severe IVH (aOR 1.02, 95% CI 0.80, 1.31), and posthemorrhagic ventricular dilatation (aOR 1.18 95% CI 0.78, 1.79) were unchanged. The only bundle component associated with improved outcomes was early patent ductus arteriosus treatment adopted by 2 sites (aOR 0.30, 95% CI 0.17, 0.55). No temporal trend in outcomes was identified.
CONCLUSION: In this large multicenter cohort, IVH-NB implementation was associated with improved practices but not with improved outcomes.
STUDY DESIGN: This multicenter, retrospective, preimplantation and postimplementation cohort study included neonates of <29 weeks' gestation admitted to Canadian neonatal intensive care units (NICUs) participating in the Canadian Neonatal Network. Sites which implemented IVH-NB were identified via a survey. Data were collected for 36 months each for preimplantation and postimplementation periods per NICU, with 1-month washout. Infants with major anomalies or admitted >2 days after birth were excluded. Primary outcome was a composite of severe IVH (grade III/IV) or death ≤ first 7 days. Secondary outcomes included severe IVH, posthemorrhagic ventricular dilatation, and severe neurological injury (severe IVH or periventricular leukomalacia).
RESULTS: Seventeen NICUs that implemented IVH-NB were included, contributing a total of 6522 infants (3216 preimplementation and 3306 postimplementation). Postimplementation, deferred cord clamping (56% vs 62%, P < .0001), prophylactic indomethacin (15% vs 19%, P < .0001), and normothermia (50% vs 56%, P < .0001) increased, and cardiopulmonary resuscitation (29% vs 25%, P < .0001) and endotracheal intubation at birth decreased (46% vs 41%, P < .0001). After implementation, aOR for the composite outcome (aOR 1.07, 95% CI 0.84, 1.35), severe IVH (aOR 1.02, 95% CI 0.80, 1.31), and posthemorrhagic ventricular dilatation (aOR 1.18 95% CI 0.78, 1.79) were unchanged. The only bundle component associated with improved outcomes was early patent ductus arteriosus treatment adopted by 2 sites (aOR 0.30, 95% CI 0.17, 0.55). No temporal trend in outcomes was identified.
CONCLUSION: In this large multicenter cohort, IVH-NB implementation was associated with improved practices but not with improved outcomes.