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. 2021 Mar 25;8(4):257. doi: 10.3390/children8040257

Table 1.

Neonatal care bundle for the prevention of IVH (based on [20]).

Patient Positioning
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    Tilt the incubator to achieve 10 to 20 degrees upper body elevation during the first week of life.

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    Supine midline position for three days with neutral head positioning.

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    Avoidance of prone position during the first week of life.

Nursing Care
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    Nursing care and medical procedures should be combined and adapted to the infant’s sleep–wake cycle.

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    Apply individualized nursing care.

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    Always question the necessity of care procedures.

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    With six care rounds per day, time intervals can be chosen between three and five hours.

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    Nursing care during the first week of life has to be performed by experienced nurses.

Care Procedures
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    Administer glucose–glycerol enemas every 12 h during the first three days of life.

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    Use closed suction systems on mechanically ventilated infants.

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    Measure head circumference and body length on the fourth day of life.

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    Measure weight on admission, then on the fourth and seventh day of life.

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    Avoid extensive cleaning of the incubator and body wash during the first week of life.

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    Perform the change of linen and measurement of weight with two nurses.

Stimulation/Pain Management
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    Use of individual tactile stimulation during nursing care.

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    Avoid stress and pain. Evaluate stress and pain using pain scales.

Light and Sound Environment
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    Avoid constant light exposure by covering the incubator. Visual monitoring must be provided.

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    Avoid noise by setting alarm tones as quietly as possible.

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    Acknowledge alarms quickly.

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    Do not place objects on the incubator.

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    Avoid noisy conversations near the incubator.

Medical Procedures
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    Endotracheal intubation has to be performed by neonatologists/senior physicians during the first week of life.

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    Drawing of blood samples from arterial lines with subsequent flushing should be performed slowly (1.5 mL/30 sec) to avoid blood pressure fluctuations.

Cranial Ultrasound
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    The first CUS has to be performed on the fourth day of life.

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    CUS has to be performed only by experienced physicians during first week of life. No routine doppler sonography.

Review of Practice
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    All cases with IVH ≥ grade 3 and PVHI should be discussed within case conferences.

IVH—germinal matrix intraventricular hemorrhage; CUS—cranial ultrasound; PVHI—periventricular hemorrhagic infarction.