Sandy Jose, DNP, APRN, NNP-BC is a board certified Neonatal Nurse Practitioner (NNP) in the Level IV Neonatal Intensive Care Unit (NICU) at Texas Children’s Hospital. She completed her NNP education at Rush University in Chicago and her DNP at UT Cizik School of Nursing in Houston. Her passion for quality improvement has helped improve neurodevelopmental outcomes for preterm neonates by reducing the risk for intraventricular hemorrhage (IVH) through the establishment of her “Mindful of Preemies” protocol. She was also a key stakeholder for the development of Neuro-Protective Guidelines for the Small Baby Unit (SBU) Program for Extremely Low Birth Weight (ELBW) neonates. In addition, she continues to actively participate in various QI initiatives within the NICU.
Intraventricular hemorrhage (IVH) is a devastating and debilitating diagnosis commonly seen in premature neonates. Statistics indicate that 45% of extremely premature infants with very low birth weight develop IVH within the first week of life. IVH is associated with numerous acute and long-term neurologic and psychiatric complications. Additionally, it has led to a progressive increase in hospital costs and length of hospitalization.
IVH is multifactorial, but it is primarily attributed to the intrinsic fragility of the germinal matrix vasculature from prematurity and disturbances in the cerebral blood flow (CBF) from commonly seen complications in premature neonates. Seminal research studies support neurodevelopmental positioning (NDP) of high-risk preterm infants as a postnatal preventive approach to reduce the risk for IVH. Hospitals with low IVH rates utilize NDP.
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