Reduction of IVH in very preterm infants via a two-step quality improvement project: a retrospective study of 14 years’ experience

Objective The introduction of quality improvement projects has been reported to be associated with a reduced rate of intraventricular haemorrhage (IVH) rate in some neonatal intensive care units. Methods In this retrospective single-centre study of 1675 preterm infants <1500 g, we analysed the frequency of overall IVH and severe IVH before and after the introduction of a first (2010) and a second (2019) quality improvement bundle. Results After the introduction of a first bundle of interventions in 2010, we were able to show a significant reduction of the rate of IVH from 22.2% to 10.5% (p=0002), mainly related to a reduction of severe IVH in the subgroup of infants below 26 weeks of gestational age. By continuous monitoring and implementation of a second intervention bundle in 2019 according to new identified risk factors, we could maintain a low rate of IVH over a 14 year period. With the reduction of the IVH rate, we observed improved long-term neurodevelopmental outcome as indicated by a lower rate of cerebral palsy and improved psychomotor development scores. Conclusion Our data suggest that implementing an intervention bundle of measures targeted to avoid risk factors may be associated with a significant reduction in IVH rate. By constant monitoring of the effects of the intervention and individual measures and refining the care bundle based on new evidence becoming available, a reduced IVH rate may be maintained despite annual fluctuations in the incidence of IVH. These intensified efforts are justified as IVH is not an inevitable event.