P1.238: Quality Improvement Initiative to Reduce Severe Intraventricular Hemorrhage in Preterm Infants in a Level III Community NICU

Purpose/Objectives: Severe intraventricular hemorrhage (IVH), defined as grade III or IV, remains a leading cause of neurodevelopmental impairment in preterm infants. The risk is highest among infants born at ≤30 weeks gestation and/or ≤1500 grams. Informed by evidence-based practices from larger centers, our community hospital NICU sought to reduce the incidence of severe IVH through implementation of a standardized prevention bundle.

Objective:
To decrease the incidence of severe IVH in preterm infants born at ≤30 weeks gestation and/or ≤1500g by 50%, from a baseline of 16% to less than 8%, during the period January 2024 to January 2025.

Design/Methods: This single-center quality improvement (QI) initiative used Institute for Healthcare Improvement (IHI) methodology. Baseline data were collected between April and December 2023. The IVH prevention bundle was launched in January 2024 and included interventions to minimize cerebral blood flow fluctuations and support optimal blood pressure regulation. Key components included strict Q6 hour two-person clustered care, avoiding leg elevation, head positioning, reduced stimulation, and staff re-education. Four Plan-Do-Study-Act (PDSA) cycles occurred during the intervention period: implementation of the bundle (January), nursing re-education and a visual board (February), protocol changes for nursing and respiratory therapy (May), and door checklist revisions with a family education outline (July–January). Inclusion criteria were infants born ≤30 weeks gestation and/or ≤1500g admitted within 24 hours of birth. Exclusion criteria included prenatal diagnosis of IVH, major congenital anomalies, or need for high-dose vasoactive medications. Outcome data were monitored using a statistical process control (P chart), with IVH rate tracked monthly. Compliance was supported through visual reminders, bedside audits, and updated nursing protocols (see attached figures).

Results: A total of 52 infants were included in the baseline period and 67 during the intervention phase. Although some infants weighed over 1500g, primary analysis focused on those meeting inclusion criteria. Following the intervention, the incidence of severe IVH decreased from 16% to 9%, representing a 44% reduction from baseline. A shift in the control chart centerline indicated special cause variation, supporting a sustained process improvement. There were no significant differences in BPD or mortality rates between the two groups. Nursing-led interventions, particularly the visual board and bedside checklists, were identified as high-impact changes (Figure 2).

Conclusion/Discussion: A structured IVH prevention bundle led to a statistically significant reduction in the incidence of severe IVH in a level III community NICU. Sustained impact appears linked to frontline nursing engagement, PDSA cycle adaptation, and visual reinforcement. Continued data collection is ongoing, with efforts underway to formalize a sustainment phase and evaluate longer-term outcomes.