Application Of Continuous Quality Improvement Strategy In Reducing Severe Intraventricular Hemorrhage In Premature Infants

Objective: To study the value of continuous quality improvement strategy to reduce severe intraventricular hemorrhage(PDSA)in very preterm infants/very low birth weight infants who were hospitalized in the neonatal intensive care unit.Methods: The first stage was to collect the baseline data of 1475 infants who met the inclusion and exclusion criteria in the NICU of our hospital from 2013 to 2020.The prevalence of severe intraventricular hemorrhage was calculated and the data were analyzed to develop strategies,and the expected target value was determined as the improvement goal.Phase two: continuous quality improvement.A total of 372 infants who met the criteria and were admitted to the NICU of our hospital from 2021 to 2022 were enrolled,and the PDSA model was used for quality improvement.Observation indicators included the incidence of severe intraventricular hemorrhage,duration of oxygen therapy,length of hospital stay,hospitalization cost,mortality,bronchopulmonary dysplasia,peripheral ventricular leukomalacia,retinopathy of prematurity,neonatal necrotizing enterocolitis and other diseases.The differences between the two groups were compared.Results:Using multivariate logistic regression analysis,it was found that intrauterine distress,postnatal intubation resuscitation,body temperature at admission<36.5℃,acidosis,perinatal infection,prolonged use of an invasive ventilator,and pre-eclampsia,and respiratory distress syndrome were risk factors for severe intraventricular hemorrhage.Prenatal magnesium sulfate and sufficient effective hormones were protective factors,and intervention measures were designed and implemented accordingly.In the end,the intervention group of severe intraventricular hemorrhage prevalence was 6.5%,the control of severe intraventricular hemorrhage prevalence was 13.15%,the incidence of the intervention group is lower than the control group,the difference was statistically significant(<0.05).The improved PVL,borderline personality disorder,and the decrease in the incidence of ROP,the difference was statistically significant.(<0.05).There were no significant changes in the prevalence of NEC,mortality,length of stay and hospitalization expenses before and after the improvement(>0.05).Conclusions: Two years of quality improvement measures in very preterm/very low birth weight infants hospitalized in NICU can reduce the incidence of severe intraventricular hemorrhage by maintaining stable vital signs after birth,timely correction of acidosis,and prevention and control of infection.The prevalence rates of BPD,ROP,and PVL in the two groups decreased during the study,which can improve the quality of life of small gestational age and low birth weight premature infants.