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Neuroprotection care bundle implementation is associated with improved long-term neurodevelopmental outcomes in extremely premature infants



To study the impact of an evidence-based neuroprotection care (NPC) bundle on long-term neurodevelopmental impairment (NDI) in infants born extremely premature.

Study design

An NPC bundle targeting predefined risk factors for acute brain injury in extremely preterm infants was implemented. We compared the incidence of composite outcome of death or severe neurodevelopmental impairment (sNDI) at 21 months adjusted age pre and post bundle implementation.


Adjusting for confounding factors, NPC bundle implementation associated with a significant reduction in death or sNDI (aOR, 0.34; 95% CI 0.17–0.68; P = 0.002), mortality (aOR, 0.31; 95% CI (0.12–0.79); P = 0.015), sNDI (aOR, 0.37; 95% CI: 0.12–0.94; P = 0.039), any motor, language, or cognitive composite score <70 (aOR, 0.48; 95% CI: 0.26–0.90; P = 0.021).


Implementation of NPC bundle targeting predefined risk factors is associated with a reduction in mortality or sNDI in extremely preterm infants.

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Fig. 1: Interrupted Time Series before and after the implementation of the NPC bundle.

Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.


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The authors also acknowledge members of the multidisciplinary team at the Neonatal Follow-up Clinic who made this work possible.


The “Drive to Zero” IVH prevention project is a nationwide initiative funded by the Canadian Neonatal Network and Canadian Preterm Birth Network. The Neonatal Neuro-Critical Care program is funded and supported by the Alberta Children’s Hospital Research Foundation and Alberta Health Services.

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Authors and Affiliations



AB led the follow up part of the study and wrote the first draft of the manuscript, PM conceptualized and the co-led the study design and implementation, HZ conceptualized and co-led the study design and implementation, ST contributed to the study design and implementation, JNS reviewed and scored all brain images and developed the scoring system, AAM contributed to the study design and implementation, MJE contributed to the study design and implementation, AL contributed to the study design and implementation, JN contributed to the study design and implementation, ST analyzed the data, CM contributed to data collection, study design and implementation, DK contributed to the study design and implementation, LI contributed to the study design and implementation, JS to data collection and study implementation, LL contributed to the study design and implementation, KM Conceptualized and led the study design and implementation. All authors drafted manuscript, critically revised manuscript, gave final approval and agree to be accountable for all aspects of work ensuring integrity and accuracy.

Corresponding author

Correspondence to Khorshid Mohammad.

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The authors declare no competing interests.

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Benlamri, A., Murthy, P., Zein, H. et al. Neuroprotection care bundle implementation is associated with improved long-term neurodevelopmental outcomes in extremely premature infants. J Perinatol 42, 1380–1384 (2022).

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