213 - Prevention of Severe Brain Injury in Very Preterm Neonates: A Quality Improvement Initiative

Poster Number: 213
Publication Number: 213.126

Zaki Yazdi, University of Alabama School of Medicine, Hoover, AL, United States; Vivek V. Shukla, University of Alabama at Birmingham, Birmingham, AL, United States; Manimaran Ramani, UAB, Birmingham, AL, United States; AKM F. Rahman, University of Alabama at Birmingham, Vestavia, AL, United States; Andrew Klinger, University of Alabama School of Medicine, Montgomery, AL, United States; Sydney E. Wright, University of Alabama School of Medicine, Irondale, AL, United States; Angela Barganier, UAB Hospital, Birmingham, AL, United States; Namasivayam Ambalavanan, University of Alabama School of Medicine, Birmingham, AL, United States; Waldemar A. Carlo, University of Alabama at Birmingham, Birmingham, AL, United States

Background: Improvement of neurodevelopmental outcomes is important in very preterm infants. Because of immaturity and poor autoregulation of blood flow, the developing brain of very preterm infants is at high risk for brain injury.

Objective: We sought to determine the impact of a neuroprotection interventions bundle (NPI) initiated at birth on the incidence of severe brain injury or early death in very preterm infants.

Design/Methods: Cohort study comparing the incidence of severe brain injury or early mortality between very preterm infants born during the pre-implementation period and post-implementation period of the NPI. A washout period of 2 months was decided a priori at the start of the intervention period. Our study was performed at the Level 4 NICU at the University of Alabama hospital. All very preterm infants 270/7 to 296/7 weeks of gestational age at birth admitted to the NICU from 1st April 2017 to 30th September 2019 were included. Brain Rescue and Avoidance of Injury in Neonates (BRAIN), an NPI bundle for the first 7 days after birth that included evidence-based best practice interventions associated with reducing the risk of severe brain injury in extremely preterm infants, was initiated in April 2018. The primary outcome was a composite outcome of early death (by 7 days) or severe brain injury defined as intraventricular hemorrhage grade 3/4 or ventriculomegaly or periventricular leukomalacia on 1 month head ultrasound.

Results: 243 infants were included, of whom 99 were from the pre-intervention period, 17 from the washout period, and 127 were from the intervention period (Table 1). There was a significant reduction in the incidence of severe brain injury or early death from Nf11/99 (11%) (pre-intervention period) to Nf0 (intervention period), p < 0.001. The intervention period was associated with a decrease in the incidence of the primary composite outcome adjusted for birthweight and Apgar score < 5 at 5 minutes (aOR=0.042, 95% CI=0.003-0.670, P-value=0.024, Table 2 and Figure 1).Conclusion(s): Implementation of an NPI bundle was associated with decreased severe brain injury or early death in very preterm infants.
Table 1: Baseline characteristics of the study participants
Table 2. Severe Brain Injury or Early Death by Study PeriodIVH grading was based on 7 day ultrasound and presence of ventriculomegaly or PVL was based on 1-month head ultrasound. Early death was defined as death by 7 days after birth. IVH= intraventricular hemorrhage and PVL= periventricular leukomalacia.