The performance of the practices associated with the occurrence of severe intraventricular hemorrhage in the very premature infants: data analysis from the Chinese neonatal network

Abstract

Background: The occurrence of severe intraventricular hemorrhage (sIVH) was high in the very preterm infants (VPIs) in China. The management strategies significantly contributed to the occurrence of sIVH in VPIs. However, the status of the perinatal strategies associated with sIVH for VPIs was rarely described across the multiple neonatal intensive care units (NICUs) in China. We aim to investigate the characteristics of the perinatal strategies associated with sIVH for VPIs across the multiple NICUs in China.

Methods: This was a retrospective analysis of data from a prospective cohort of Chinese Neonatal Network (CHNN) dataset, enrolling infants born at 24⁺⁰-31⁺⁶ from 2019 to 2021. Eleven perinatal practices performed within the first 3 days of life were investigated including antenatal corticosteroids use, antenatal magnesium sulphate therapy, intubation at birth, placental transfusion, need for advanced resuscitation, initial inhaled gas of 100% FiO2 in delivery room, initial invasive respiratory support, surfactant and caffeine administration, early enteral feeding, and inotropes use. The performances of these practices across the multiple NICUs were investigated using the standard deviations of differences between expected probabilities and observations. The occurrence of sIVH were compared among the NICUs.

Results: A total of 24,226 infants from 55 NICUs with a mean (SD) gestational age of 29.5 (1.76) and mean (SD) birthweight of 1.31(0.32) were included. sIVH was detected in 5.1% of VPIs. The rate of the antenatal corticosteroids, MgSO4 therapy, and caffeine was 80.0%, 56.4%, and 31.5%, respectively. We observed significant relationships between sIVH and intubation at birth (AOR 1.52, 95% CI 1.13 to 1.75) and initial invasive respiratory support (AOR 2.47, 95% CI 2.15 to 2.83). The lower occurrence of sIVH (4.8%) was observed corresponding with the highest utility of standard antenatal care, the lowest utility of invasive practices, and early enteral feeding administration.

Conclusions: The current evidence-based practices were not performed in each VPI as expected among the studied Chinese NICUs. The higher utility of the invasive practices could be related to the occurrence of sIVH.

Keywords: Multiple neonatal intensive care units; Practice; Prematurity; Severe intraventricular hemorrhage.

Fig. 1

The workflow of this study

Fig. 2

The performances of the early care practices among the enrolled very preterm infants. A The percentage of utility of the care practices among the enrolled very preterm infants. B The standard deviation of the performance of the care practices among the enrolled very preterm infants. The higher SD meant higher variation. The expected model of inotropes given is difficult to build logistic regression models based on the limited information from the CHNN database. Therefore, we could not standardize the practice of the inotropes given

Fig. 3

The risk-adjusted odds ratios of the care practices for severe intraventricular hemorrhage after adjustment for the perinatal clinical characteristics. The regressions of the antenatal corticosteroids and MgSO4 therapy controlled for birthweight, gestational age, Apgar 5 score less than 5, EOS, inotropes given, invasive respiratory support; The regressions of the intubation at birth, placenta transfusion, advanced resuscitation, initially inhaled gas of 100% FiO2 controlled for birthweight, gestational age, EOS, inotropes given, Apgar 5 score less than 5, invasive respiratory support; The regressions of the invasive respiratory support controlled for birthweight, gestational age, Apgar 5 score less than 5, EOS, inotropes given; The regressions of the caffeine given controlled for birthweight, gestational age, EOS, inotropes given, Apgar 5 score less than 5, invasive respiratory support; The regression of the early enteral feeding controlled for birthweight, gestational age, EOS, inotropes given, Apgar 5 score less than 5, invasive respiratory support; The regression of the inotropes given controlled for birthweight, gestational age, EOS, Apgar 5 score less than 5, invasive respiratory support. The regression of the surfactant given controlled for birthweight, gestational age, EOS, Apgar 5 score less than 5, inotropes given, invasive respiratory support

Fig. 4

The clusters of the practices and the outcomes among the different clusters. A The two clusters of the practices. B The occurrence of sIVH among the two clusters