Implementing a Minimal Stimulation Guideline to Decrease the Risk of Intraventricular Hemorrhage

Background: Intraventricular hemorrhage (IVH) is a significant cause of mortality and morbidity in preterm infants. It is a condition most often affecting infants born less than 32 weeks' gestation, and more likely occurring with decreasing gestational age. The majority of IVH occurs during the first week of life and infants can be especially susceptible during the first 72 hours. Often, IVH is a result of alterations in the cerebral blood flow causing rupture and hemorrhage of fragile blood vessels in the preterm infant brain. Purpose: A thorough review of the literature shows that routine aspects of neonatal care affect an infant's blood pressure and cerebral blood flow and can contribute to IVH. Many newborn intensive care units (NICU) have implemented guidelines that encourage minimal stimulation of preterm infants by limiting environmental and external stimulation in an effort to decrease the IVH incidence rate. The purpose of this project is to develop and implement a minimal stimulation guideline in a level three NICU and then evaluate the compliance to the guidelines and any barriers staff encounter during the implementation process. Methods: The IVH incidence rate in the NICU was determined by reviewing the number of infants diagnosed with IVH during the calendar year 2017. A minimal stimulation guideline was developed. Nursing staff members were educated regarding IVH and the benefit of minimal stimulation. The guideline was implemented in the NICU for infants born less than 29 weeks' gestation or less than 1000 grams at birth. A questionnaire was used to evaluate the compliance to the guideline and any barriers the nursing staff experienced while utilizing the minimal stimulation guideline. The data collected from the questionnaires were analyzed and recommendations for further use of the minimal stimulation guideline were made to the key stake holders. Results: Thirty-nine surveys were completed. The data was analyzed and the results indicate that 50% of the nurses were at least "moderately familiar" with the guideline and that the unit adhered to the guideline well. Compliance with the various aspects of the guideline was high, with the exception of completing the admission process in one hour. Barriers were identified based on questionnaire responses. Conclusions: Despite the limitations, the information gleaned from this project will help guide the further use of minimal stimulation going forward. Minimal stimulation will not prevent all IVH from occurring but it does promote developmentally appropriate care and encourage healthcare providers to examine how their interactions with an extremely preterm infant can alter that infant's outcomes.