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Neonatal care bundles are associated with a reduction in the incidence of intraventricular haemorrhage in preterm infants: a multicentre cohort study
  1. Karen de Bijl-Marcus1,
  2. Annemieke Johanna Brouwer2,
  3. Linda S De Vries1,
  4. Floris Groenendaal1,
  5. Gerda van Wezel-Meijler3
  1. 1 Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2 Department Bachelor of Nursing, Faculty of Health Care, Utrecht University of Applied Sciences, Utrecht, The Netherlands
  3. 3 Department of Neonatology, Isala Hospitals, Zwolle, The Netherlands
  1. Correspondence to Dr Karen de Bijl-Marcus, Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht 3584EA, The Netherlands; k.a.marcus{at}


Objective To investigate the effect of a nursing intervention bundle, applied during the first 72 hours of life, on the incidence of germinal matrix-intraventricular haemorrhage (GMH-IVH) in very preterm infants.

Design Multicentre cohort study.

Setting Two Dutch tertiary neonatal intensive care units.

Patients The intervention group consisted of 281 neonates, whereas 280 infants served as historical controls (gestational age for both groups <30 weeks).

Interventions After a training period, the nursing intervention bundle was implemented and applied during the first 72 hours after birth. The bundle consisted of maintaining the head in the midline, tilting the head of the incubator and avoidance of flushing/rapid withdrawal of blood and sudden elevation of the legs.

Main outcome measures The incidence of GMH-IVH occurring and/or increasing after the first ultrasound (but within 72 hours), cystic periventricular leukomalacia and/or in-hospital death was the primary composite outcome measure. Logistic regression analysis was used to explore differences between groups.

Results The nursing intervention bundle was associated with a lower risk of developing a GMH-IVH (any degree), cystic periventricular leukomalacia and/or mortality (adjusted OR 0.42, 95% CI 0.27 to 0.65). In the group receiving the bundle, also severe GMH-IVH, cystic periventricular leukomalacia and/or death were less often observed (adjusted OR 0.54, 95% CI 0.33 to 0.91).

Conclusions The application of a bundle of nursing interventions is associated with reduced risk of developing a new/progressive (severe) GMH-IVH, cystic periventricular leukomalacia and/or mortality in very preterm infants when applied during the first 72 hours postnatally.

  • intraventricular hemorrhage
  • head position
  • preterm infant
  • tilting
  • nursing care

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.