112 - Prevention of Intraventricular Hemorrhage in Extremely Low Birth Weight Infants at a Single-Center Level IV NICU: A Quality Improvement Initiative

Publication Number: 3107.112

Kelley Hillman, University of Oklahoma HSC, Edmond, OK, United States; Ulana Pogribna, Oklahoma Childrens Hospital at OU Health, Oklahoma City, OK, United States; Susan Bedwell, Oklahoma Childrens Hospital at OU Health, Guthrie, OK, United States

Background: Extremely preterm infants are susceptible to intraventricular hemorrhage (IVH), with lower gestation and birth weight carrying the highest risk. IVH is associated with significant mortality and morbidity, emphasizing the importance of prevention. In 2021, the national median percentage of severe IVH in very low birth weight infants at Oklahoma Children's Hospital was 18% compared to 7% nationally. Despite the launch of extremely low birth weight (ELBW) clinical pathways in Q4 '22, IVH rates increased, demonstrating a need for further interventions.

Objective: The project aim is to decrease total and severe IVH rates by ≥10% among ELBW infants in the Oklahoma Children's NICU from Q2 '24 to Q2 '26.

Design/Methods: A multidisciplinary stakeholder group applied IHI Model for Improvement to guide the initiative. Total and severe IVH rates (outcome measures) and mortality (balancing measure) were calculated on every eligible ELBW infant (≤28 weeks, ≤1000 g) on a quarterly basis. PDSA 1 in Q3 '24 focused on thermoregulation and oxygen weaning protocol integration. PDSA 2 in Q4 '24 included ELBW nursing modules/skills labs and an ELBW admission order set. PDSA 3 in Q1 '25 included reinforcing maintenance of normoxia with staff. PDSA 4 in Q2 '25 included expanded respiratory therapy and nursing education, T-piece manual resuscitation integration, and institution of quarterly ELBW town halls for ELBW staff. PDSA 5 in Q3 '25 focused on using cross-ventilation and increasing transport isolette temperatures. Throughout the initiative, multiple meetings were held to provide unit updates on clinical practice changes. Data analysis will be completed by January 2026.

Results: Prior to project implementation, 153 eligible ELBW infants were identified with average rates of total and severe IVH of 53% and 25%, respectively. Since project initiation, 71 eligible ELBW infants have been identified and average total and severe IVH rates have decreased to 28% and 8%, respectively (Fig. A and B). Maintenance of normoxia and normothermia emerged as key process measures. The average mortality rate remained stable from 22% to 23% in the same period (Fig. C).

Conclusion(s): Since project initiation, a decreasing trend in total and severe IVH rates has been observed. We anticipate lasting improvement in rates of IVH, and a statistically significant shift would be demonstrated if Q4 2025 remains below the mean. Additionally, this work revealed that current IVH prevention bundles may need to be expanded to include further interventions-such as maintaining normothermia and normoxia-and to ensure sustained adherence after implementation.

Rate of Total IVH in ELBW Infants


Rate of Severe IVH in ELBW Infants


ELBW Mortality Rates by Gestational Age