Impact of a minimal handling care protocol on intraventricular hemorrhage in preterm infants: a retrospective cohort study

Abstract

Background: Premature birth is associated with a high risk of mortality and neurodevelopmental morbidity, with intraventricular hemorrhage (IVH) remaining a major cause of brain injury in preterm infants. Neuroprotective care bundles focusing on minimal handling have been proposed to reduce physiological stress and cerebral hemodynamic instability. While such bundles have been associated with reduced rates of severe intraventricular hemorrhage, evidence regarding the isolated impact of minimal handling—particularly on other neonatal morbidities—remains limited. Methods: This retrospective comparative cohort study was conducted in a tertiary-level neonatal intensive care unit between January 2020 and December 2023. Preterm infants with a gestational age ≤ 32 weeks and birth weight ≤ 1500 g were included. Outcomes were compared between a pre-bundle period (2020–2021) and a post-bundle period (2022–2023), following the unit-wide implementation of a structured minimal handling care protocol during the first 72 h of life. The primary outcome was the incidence and severity of IVH diagnosed by cranial ultrasonography. Secondary outcomes included major neonatal morbidities and mortality. Multivariable logistic regression was used to identify independent risk factors for IVH. Results: A total of 112 infants were included (46 pre-bundle, 66 post-bundle). The overall incidence and severity distribution of IVH did not differ significantly between groups. Rates of necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity, sepsis, and mortality were also comparable. In multivariable analysis, maternal diabetes and nosocomial sepsis were identified as factors associated with IVH. Conclusion: Implementation of a minimal handling care bundle was feasible and safe in a tertiary neonatal intensive care unit. However, due to the limited sample size and low number of IVH events, its effect on the incidence and severity of IVH could not be clearly delineated.