{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:23:36Z","timestamp":1787027016022,"version":"build-2736575974"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Severe IVH (SIVH) stands out as a leading cause of poor neuro-developmental outcomes, including cognitive, attention and motor impairment in very low birth weight (\u22641.5\u2005kg, VLBW) infants. The study aims to reduce the rate of severe intraventricular hemorrhage (SIVH) by 50% in very low birth weight (VLBW) infants admitted to the level III C neonatal intensive care unit (NICU) in Singapore.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      In this quality improvement (QI) study, VLBW infants admitted to NICU from 2011 to 2021 (\n                      <jats:italic>n<\/jats:italic>\n                      = 2215) were categorized into four periods: (a) pre-intervention 2011to 2012, (b) Intervention (2013 to 2017), (c) post-intervention (2018 to 2019), and (d) sustainment (2020 to 2021) periods, respectively. A multidisciplinary team identified key drivers for SIVH. A set of care bundles involving eight protocolized interventions was applied. Infants with SIVH were analyzed with an RC-PC-S process (Root Cause- Process Compliance - System), which includes a structured template by a Quality Assurance (QA) committee; recommendations were implemented in the unit to modify practices. Data were collected prospectively, and univariate and multivariate logistic regression analyses were conducted.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 2,215 Infants who met the study criteria, Ninety infants were excluded. Detailed data were collected from 2,125 infants (390, 1,000, 370, and 365 in the baseline, intervention, post-intervention, and sustainment periods, respectively). The mean gestational age was 28\u00b76 and 28.8 in the intervention and post-intervention periods, respectively, and were comparable across the 4 study periods. The rate of SIVH was 5.9% in the pre-intervention period and 4.4% and 1.9% (adjusted OR 0.266,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006, 44\/1,000 vs. 7\/370) in the intervention and the post-intervention periods, respectively, representing a reduction of 57%. The rate of SIVH in the sustainment period was 2\u00b77%. The reduced SIVH was associated with reduced mortality, adherence to process measures, and no change in balancing measures.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A multipronged modified QI approach implementing an evidence-based SIVH prevention bundle and RC-PC-S analysis was associated with a sustained significant reduction in the rate of SIVH in VLBW infants. RC-PC-S is a potential QI tool for reducing severe IVH and other key neonatal morbidities in VLBW infants.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2025.1640964","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T04:12:27Z","timestamp":1759119147000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["A sustained reduction in the rate of severe intraventricular hemorrhage in very low birth weight infants: a novel quality improvement project in a large perinatal-neonatal centre in Asia"],"prefix":"10.3389","volume":"13","author":[{"given":"Thowfique","family":"Ibrahim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arpan","family":"Agarwal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul Alim","family":"Abdul Haium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nirmal Kavalloor","family":"Visruthan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Chona","family":"Badillo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rowena","family":"Dela Puerta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janlie Lizaso","family":"Banas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharifa","family":"Sarjono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fareed Muhammed Bin","family":"Noorul Amin Alawdeen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rehana","family":"Sultana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor Samuel","family":"Rajadurai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1055\/s-0029-1214237","article-title":"Severe intraventricular hemorrhage in preterm infants: comparison of risk factors and short-term neonatal morbidities between grade 3 and grade 4 intraventricular hemorrhage","volume":"26","author":"Sarkar","year":"2009","journal-title":"Am J Perinatol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1016\/S0022-3476(78)80282-0","article-title":"Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500\u2005gm","volume":"92","author":"Papile","year":"1978","journal-title":"J Pediatr"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e2022057442","DOI":"10.1542\/peds.2022-057442","article-title":"Preterm brain injury and neurodevelopmental outcomes: a meta-analysis","volume":"150","author":"Rees","year":"2022","journal-title":"Pediatrics"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1132","DOI":"10.1542\/peds.2015-0944","article-title":"Periventricular\/intraventricular hemorrhage and neurodevelopmental outcomes: a meta-analysis","volume":"136","author":"Mukerji","year":"2015","journal-title":"Pediatrics"},{"key":"B5","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1542\/peds.2013-0372","article-title":"New South Wales And Australian capital territory neonatal intensive care Units\u2019 data collection. 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