Best evidence summary for the prevention of intraventricular hemorrhage in preterm infants: a systematic review.

BACKGROUND

With continuous advances in neonatal intensive care, the survival of preterm infants has improved substantially. However, intraventricular hemorrhage (IVH) remains one of the most serious complications of prematurity and is associated with death and long-term neurodevelopmental impairment. A growing body of evidence suggests that timely preventive interventions can reduce the incidence and severity of IVH. This study aimed to systematically retrieve, appraise, and synthesize the best available evidence on IVH prevention in preterm infants, so as to provide practical references for perinatal and neonatal intensive care.

METHODS

Based on the "6S" evidence pyramid model, we searched multiple databases and resources. Evidence was searched in clinical decision support resources, guideline repositories, evidence-based databases, and major English and Chinese literature databases, including British Medical Journal (BMJ), UpToDate, National Institute for Health and Care Excellence (NICE), Guidelines International Network (GIN), Medlive, American Heart Association (AHA), American Academy of Pediatrics (AAP), Joanna Briggs Institute databases (JBI), Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Web of Science, SinoMed, Wanfang Data, and China National Knowledge Infrastructure (CNKI). The search timeframe was from January 2015 to December 2025. Eligible publications included clinical decisions, guidelines, systematic reviews, evidence summaries, expert consensus documents, best practice implementation projects, and randomized controlled trials (RCTs). We extracted evidence from the included literature, summarized and graded it into evidence summaries.

RESULTS

A total of 20 publications were included, comprising 2 clinical decision resources, 4 guidelines, 6 systematic reviews, 2 evidence summaries, 2 expert consensus documents, 1 best practice implementation report, and 3 RCTs. A total of 46 pieces of best evidence were synthesized and categorized into ten domains: prevention principles, risk factor identification, antenatal preparation, immediate intrapartum and postnatal management, thermoregulation, oxygen therapy support, blood pressure monitoring and assessment, glycemic management, care bundles, and training and education.

CONCLUSIONS

This study synthesizes 46 pieces of best evidence for preventing IVH in preterm infants, providing a robust foundation for clinical practice. However, clinical translation may encounter barriers related to local healthcare policies, equipment constraints, and human resources. When implementing these recommendations, practitioners must carefully evaluate the source context, evidence grading, and institutional adaptability to ensure effective evidence-based practice.