From the Research
The IVH prevention bundle should be implemented for all premature infants born at less than 30 weeks gestational age or weighing less than 1500 grams, with highest priority for those born at less than 28 weeks, as the most recent and highest quality study 1 suggests that current dosing may not provide sufficient exposure to prevent IVH.
Key Components of the IVH Prevention Bundle
- Midline head positioning to reduce cerebral blood flow fluctuations
- Minimal handling protocols to minimize stress and fluctuations in blood pressure
- Delayed cord clamping (30-60 seconds) to reduce shock and promote stable blood flow
- Careful blood pressure management to avoid fluctuations
- Maintaining normal PCO2 levels (avoiding hypocarbia and hypercarbia) to prevent cerebral vasoconstriction or vasodilation
- Slow intravenous fluid boluses when needed to prevent rapid changes in blood volume
Implementation and Duration
The IVH prevention bundle should be initiated immediately after birth and continued for at least 72 hours of life, as this is the period of highest risk for IVH 2. Some centers may extend bundle implementation to 5-7 days for extremely premature infants.
Risk Factors for IVH
Several risk factors for IVH have been identified, including low birth weight, low gestational age, need for mechanical ventilation, pneumothorax, and low 5-minute Apgar scores 3. These risk factors should be taken into account when implementing the IVH prevention bundle.
Medications and Interventions
Indomethacin may be used as part of the IVH prevention bundle, but its efficacy and safety profile should be carefully considered, as recent studies suggest that current dosing may not provide sufficient exposure to prevent IVH 1. Other medications and interventions, such as antenatal corticosteroids and careful timing of surfactant administration, may also be beneficial in reducing the risk of IVH 4, 5.