Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.
Advertisement
Journal of Perinatology (2022)
Metrics details
To determine whether an intraventricular hemorrhage (IVH) prevention bundle featuring midline-elevated positioning reduced IVH among high-risk infants.
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.
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.
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.
This is a preview of subscription content, access via your institution
Subscribe to Journal
Get full journal access for 1 year
$119.00
only $9.92 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Buy article
Get time limited or full article access on ReadCube.
$32.00
All prices are NET prices.
De-identified study data as well as the R code for the analysis is available on request with permission of the University of Washington Institutional Review Board.
Carteaux P, Cohen H, Check J, George J, McKinley P, Lewis W, et al. Evaluation and Development of Potentially Better Practices for the Prevention of Brain Hemorrhage and Ischemic Brain Injury in Very Low Birth Weight Infants. Pediatrics 2003;111:e489–96.
Article PubMed Google Scholar
McLendon D, Check J, Carteaux P, Michael L, Moehring J, Secrest JW, et al. Implementation of potentially better practices for the prevention of brain hemorrhage and ischemic brain injury in very low birth weight infants. Pediatrics 2003;111:e497–503.
Article PubMed Google Scholar
de Bijl-Marcus KA, Brouwer AJ, de Vries LS, van Wezel-Meijler G. The Effect of Head Positioning and Head Tilting on the Incidence of Intraventricular Hemorrhage in Very Preterm Infants: A Systematic Review. Neonatology 2017;111:267–79.
Article PubMed Google Scholar
de Bijl-Marcus K, Brouwer AJ, De Vries LS, Groenendaal F, Wezel-Meijler Gvan. Neonatal care bundles are associated with a reduction in the incidence of intraventricular haemorrhage in preterm infants: a multicentre cohort study. Arch Dis Child Fetal Neonatal Ed 2020;105:419–24.
Article PubMed Google Scholar
Brew N, Walker D, Wong FY. Cerebral vascular regulation and brain injury in preterm infants. Am J Physiol Regul Integr Comp Physiol 2014;306:R773–86.
Article CAS PubMed Google Scholar
Schmid MB, Reister F, Mayer B, Hopfner RJ, Fuchs H, Hummler HD. Prospective risk factor monitoring reduces intracranial hemorrhage rates in preterm infants. Dtsch Arzteblatt Int 2013;110:489–96.
Google Scholar
Romantsik O, Calevo MG, Bruschettini M. Head midline position for preventing the occurrence or extension of germinal matrix‐intraventricular haemorrhage in preterm infants. Cochrane Database Syst Rev [Internet]. 2020. https://www.readcube.com/articles/10.1002%2F14651858.cd012362.pub3
Textor J, van der Zander B, Gilthorpe MS, Liśkiewicz M, Ellison GTH. Robust causal inference using directed acyclic graphs: the R package ‘dagitty’. Int J Epidemiol. 2016;45:1887–94.
Guo J, Gabry J, Goodrich B, Weber S, Lee D, Sakrejda K, et al. rstan: R Interface to Stan [Internet]. 2022. https://CRAN.R-project.org/package=rstan
Gabry J, Ali I, Brilleman S, Novik JB, AstraZeneca, University T of C, et al. rstanarm: Bayesian Applied Regression Modeling via Stan [Internet]. 2022. https://CRAN.R-project.org/package=rstanarm
Wickham H, RStudio. tidyverse: Easily Install and Load the “Tidyverse” [Internet]. 2021. https://CRAN.R-project.org/package=tidyverse
Becker J, Chan C hong, Chan GC, Leeper TJ, Gandrud C, MacDonald A, et al. rio: A Swiss-Army Knife for Data I/O [Internet]. 2021. https://CRAN.R-project.org/package=rio
Xie Y, Sarma A, Vogt A, Andrew A, Zvoleff A, Simon A, et al. knitr: A General-Purpose Package for Dynamic Report Generation in R [Internet]. 2022. https://CRAN.R-project.org/package=knitr
Spinu V, Grolemund G, Wickham H, Vaughan D, Lyttle I, Costigan I, et al. lubridate: Make Dealing with Dates a Little Easier [Internet]. 2021. https://CRAN.R-project.org/package=lubridate
McElreath R rethinking package – RDocumentation [Internet]. [cited 2022 Apr 29]. https://www.rdocumentation.org/packages/rethinking/versions/2.13
Dogucu M, Johnson A, Ott M bayesrules: Datasets and Supplemental Functions from Bayes Rules! Book [Internet]. 2021 [cited 2022 Apr 29]. https://CRAN.R-project.org/package=bayesrules
Gabry J, Mahr T, Bürkner PC, Modrák M, Barrett M, Weber F, et al. bayesplot: Plotting for Bayesian Models [Internet]. 2022 [cited 2022 Apr 29]. https://CRAN.R-project.org/package=bayesplot
Kay M, Mastny T tidybayes: Tidy Data and “Geoms” for Bayesian Models [Internet]. 2022 [cited 2022 Apr 29]. https://CRAN.R-project.org/package=tidybayes
Bolker B, Robinson D, Menne D, Gabry J, Buerkner P, Hua C, et al. broom.mixed: Tidying Methods for Mixed Models [Internet]. 2022 [cited 2022 Apr 29]. https://CRAN.R-project.org/package=broom.mixed
Wickham H, RStudio. modelr: Modelling Functions that Work with the Pipe [Internet]. 2020 [cited 2022 Apr 29]. https://CRAN.R-project.org/package=modelr
Wickham H, RStudio. forcats: Tools for Working with Categorical Variables (Factors) [Internet]. 2021 [cited 2022 Apr 29]. https://CRAN.R-project.org/package=forcats
Vehtari A, Gabry J, Magnusson M, Yao Y, Bürkner PC, Paananen T, et al. loo: Efficient Leave-One-Out Cross-Validation and WAIC for Bayesian Models [Internet]. 2022 [cited 2022 Apr 29]. https://CRAN.R-project.org/package=loo
Gross M, Engel C, Trotter A. Evaluating the Effect of a Neonatal Care Bundle for the Prevention of Intraventricular Hemorrhage in Preterm Infants. Children 2021;8:257.
Article PubMed PubMed Central Google Scholar
Ferreira DM, Girão ALA. e Silva AVS, Chaves EMC, de Almeida PC, Freire VS, et al. Application of a Bundle in the Prevention of Peri-Intraventricular Hemorrhage in Preterm Newborns. J Perinat Neonatal Nurs 2020;34:E5.
Article PubMed Google Scholar
Wallau CAK, Costa-Nobre DT, Leslie ATFS, Guinsburg, Ruth. Impact of bundle implementation on the incidence of peri/intraventricular hemorrhage among preterm infants: a pre-post interventional study. Sao Paulo Med J Rev Paul Med [Internet]. 2021 [cited 2022 Jun 6];139. https://pubmed.ncbi.nlm.nih.gov/33978129/
Emery JR, Peabody JL. Head position affects intracranial pressure in newborn infants. J Pediatr. 1983;103:950–3.
Article CAS PubMed Google Scholar
Cowan F, Thoresen M. Changes in Superior Sagittal Sinus Blood Velocities Due to Postural Alterations and Pressure on the Head of the Newborn Infant. Pediatrics 1985;75:1038–47.
Article CAS PubMed Google Scholar
Pellicer A, Gayá F, Madero R, Quero J, Cabañas F. Noninvasive Continuous Monitoring of the Effects of Head Position on Brain Hemodynamics in Ventilated Infants. Pediatrics 2002;109:434–40.
Article PubMed Google Scholar
Liao SMC, Rao R, Mathur AM. Head Position Change Is Not Associated with Acute Changes in Bilateral Cerebral Oxygenation in Stable Preterm Infants during the First 3 Days of Life. Am J Perinatol. 2015;32:645–52.
PubMed Google Scholar
Spengler D, Loewe E, Krause MF. Supine vs. Prone Position With Turn of the Head Does Not Affect Cerebral Perfusion and Oxygenation in Stable Preterm Infants ≤32 Weeks Gestational Age. Front Physiol. 2018;9:1664.
Article PubMed PubMed Central Google Scholar
Murthy P, Zein H, Thomas S, Scott JN, Abou Mehrem A, Esser MJ, et al. Neuroprotection Care Bundle Implementation to Decrease Acute Brain Injury in Preterm Infants. Pediatr Neurol. 2020;110:42–8.
Article PubMed Google Scholar
Kumar P, Carroll KF, Prazad P, Raghavan A, Waruingi W, Wang H. Elevated supine midline head position for prevention of intraventricular hemorrhage in VLBW and ELBW infants: a retrospective multicenter study. J Perinatol J Calif Perinat Assoc. 2021;41:278–85.
Google Scholar
Persad N, Kelly E, Amaral N, Neish A, Cheng C, Fan CPS, et al. Impact of a “Brain Protection Bundle” in Reducing Severe Intraventricular Hemorrhage in Preterm Infants <30 Weeks GA: A Retrospective Single Centre Study. Children 2021;8:983.
Article PubMed PubMed Central Google Scholar
Kochan M, Leonardi B, Firestine A, McPadden J, Cobb D, Shah TA, et al. Elevated midline head positioning of extremely low birth weight infants: effects on cardiopulmonary function and the incidence of periventricular-intraventricular hemorrhage. J Perinatol J Calif Perinat Assoc. 2019;39:54–62.
Google Scholar
Al-Abdi SY, Nojoom MS, Alshaalan HM, Al-Aamri MA. Pilot-randomized study on intraventricular hemorrhage with midline versus lateral head positions. Saudi Med J. 2011;32:420–1.
PubMed Google Scholar
Muething SE. Improving Patient Outcomes by Standardizing Care. J Pediatr. 2005;147:568–70.
Article PubMed Google Scholar
ACOG Clinical Guidelines and Standardization of Practice to Improve Outcomes [Internet]. [cited 2022 Jun 10]. https://www.acog.org/en/clinical/clinical-guidance/committee-opinion/articles/2019/10/clinical-guidelines-and-standardization-of-practice-to-improve-outcomes
Gagliardi L, Rusconi F, Da Frè M, Mello G, Carnielli V, Di Lallo D, et al. Pregnancy disorders leading to very preterm birth influence neonatal outcomes: results of the population-based ACTION cohort study. Pediatr Res. 2013;73:794–801.
Article PubMed Google Scholar
Download references
We are grateful to Kristel Hallson who provided invaluable assistance in abstracting medical records.
BJS-al-Haddad has been supported by T32 GM008244 from the National Institute of General Medical Sciences.
University of Minnesota Department of Pediatrics, Division of Neonatology, Minneapolis, MN, USA
Benjamin J. S. al-Haddad
University of Washington School of Medicine, Seattle, WA, USA
Brittany Bergam, Taylor Thompson & Jacob Kennedy
Macalester College, Mathematics, Statistics, and Computer Science, St. Paul, MN, USA
Alicia Johnson
University of Washington Department of Pediatrics, Division of Neonatology, Seattle, WA, USA
Sarah Kolnik, Krystle M. Perez, Sandra E. Juul & Kendell German
Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
Daniel A. Enquobahrie
You can also search for this author in PubMed Google Scholar
You can also search for this author in PubMed Google Scholar
You can also search for this author in PubMed Google Scholar
You can also search for this author in PubMed Google Scholar
You can also search for this author in PubMed Google Scholar
You can also search for this author in PubMed Google Scholar
You can also search for this author in PubMed Google Scholar
You can also search for this author in PubMed Google Scholar
You can also search for this author in PubMed Google Scholar
You can also search for this author in PubMed Google Scholar
BJSH designed the study, completed the analysis, and drafted the paper. BB worked on abstracting the data and writing the paper. SK worked on the evidence for the model framework, study design and contributed to writing the paper. TT worked on abstracting the data and writing the paper. AJ provided statistical expertise, worked on the statistical models, and helped write the paper. KP worked on the evidence for the model framework and contributed to writing the paper. JK worked on abstracting the data and writing the paper. DE helped design the modeling strategy and with writing the paper. SJ helped work on the model framework and contributed to writing the paper. KG worked on the evidence for the model framework, study design and contributed to writing the paper.
Correspondence to Benjamin J. S. al-Haddad.
The authors declare no competing interests.
This study was approved by the University of Washington IRB committee (study number STUDY00011520). This work was performed in accordance with the Declaration of Helsinki.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
Reprints and Permissions
al-Haddad, B.J.S., Bergam, B., Johnson, A. et al. Effectiveness of a care bundle for primary prevention of intraventricular hemorrhage in high-risk neonates: a Bayesian analysis. J Perinatol (2022). https://doi.org/10.1038/s41372-022-01545-9
Download citation
Received:
Revised:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41372-022-01545-9
Anyone you share the following link with will be able to read this content:
Sorry, a shareable link is not currently available for this article.
Provided by the Springer Nature SharedIt content-sharing initiative
Advertisement
© 2022 Springer Nature Limited