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PEDIATRICS Vol. 111 No. 4 April 2003, pp. e497-e503

ELECTRONIC ARTICLE

Implementation of Potentially Better Practices for the Prevention of Brain Hemorrhage and Ischemic Brain Injury in Very Low Birth Weight Infants

Debra McLendon, RN, BSN*, Jennifer Check, BS*, Patricia Carteaux, RN{ddagger}, Laura Michael, RN{ddagger}, Jim Moehring, RRT{ddagger}, Joel W. Secrest, MD{ddagger}, Sue E. Clark, MD§, Howard Cohen, MD§, Sharon A. Klein, MS, NNP§, Diane Boyle, RN, MBA||, Jeffrey A. George, DO||, Susan Okuno-Jones, RN, BSN, MA||, Debora S. Buchanan, RNC, NNP, Pam McKinley, RN and Jonathan M. Whitfield, MB ChB

* New Hanover Regional Medical Center, Wilmington, North Carolina
{ddagger} Parkview Hospital, Fort Wayne, Indiana
§ Children’s Hospital of Illinois at OSF St Francis Medical Center, Peoria, Illinois
|| Lutheran General Children’s Hospital, Park Ridge, Illinois
Baylor University Medical Center, Dallas, Texas

--> Objective. Using an evidence-based approach, a Vermont Oxford Network focus group whose goal was to reduce brain injury developed and implemented a number of potentially better practices. Each center approached implementation of the practices differently. Reducing the incidence of intraventricular hemorrhage and periventricular leukomalacia are important for improving long-term outcomes for low birth weight infants.

Methods. Implementation approaches for some but not all of the practices at the various centers are discussed. The practices reviewed include optimal peripartum management, such as resuscitation, avoidance of hypothermia, optimal surfactant delivery, early neonatal management by the most experienced providers, and measures to minimize pain and stress. Additional practices include maintenance of neutral head positioning, fluid volume therapy for hypotension, indomethacin prophylaxis, ventilator management, avoidance of routine suctioning, and limiting the use of sodium bicarbonate and postnatal dexamethasone.

Results. Approaches to implementation were center specific, and results vary. Although some practices were easier to implement than others, communication, education, and leadership were critical to the process.

Conclusions. The quality improvement multidisciplinary approach is a useful tool for finding ways to reduce the incidence of intraventricular hemorrhage and periventricular leukomalacia.

Key Words: intraventricular hemorrhage • periventricular leukomalacia • potentially better practice • very low birth weight • cranial ultrasonography • collaborative quality improvement • NIC/Q 2000 • NHRMC, New Hanover Regional Medical Center • HFOV, high-frequency oscillating ventilation

Abbreviations: PBPs, potentially better practices • NICU, neonatal intensive care unit • IVH, intraventricular hemorrhage • PVL, periventricular leukomalacia • VLBW, very low birth weight • NIC/Q 2000, Neonatal Intensive Care Quality Improvement Collaborative Year 2000 • CHOI, Children’s Hospital of Illinois at OSF St Francis Medical Center • LGCH, Lutheran General Children’s Hospital • PCO2, partial pressure of carbon dioxide • MBP, mean blood pressure • HFOV, high-frequency oscillating ventilation

Received for publication Aug 13, 2002; Accepted Oct 24, 2002.