Supplementary Material for: Interventions to Prevent Intraventricular Haemorrhage in Preterm Neonates: An Umbrella Review of Systematic Reviews and Meta-analyses

Objective:
To conduct an overview of systematic reviews of RCTs assessing the effects of perinatal/neonatal interventions in reducing IVH among preterm infants.

Methods:
PUBMED, EMBASE, Cochrane database for systematic reviews, and systematic review repositories were searched for meta-analyses of RCTs involving preterm infants or women at high risk of preterm birth and reporting on IVH. Metaumbrella package of R software was used to pool outcome data for each intervention. Quality of the systematic reviews were assessed using AMSTAR 2 tool. Certainty of evidence (COE) was reported using GRADE recommendations.

Results:
A total of 148 systematic reviews (110 Cochrane vs 38 non-Cochrane) were included. Postnatal interventions were reported in 118 reviews. Severe IVH was reported in 100/148 reviews that included 39483 infants and 20400 antenatal women. 78% (n=116) of the reviews were rated high or moderate quality on AMSTAR -2 assessment.
Antenatal corticosteroids and magnesium sulphate for imminent preterm birth, volume targeted ventilation, early rescue surfactant administration through thin catheter, prophylactic indomethacin significantly reduced the rates of severe IVH (moderate COE). Use of respiratory function monitors and heated humidified respiratory gases in the delivery room and early prophylactic erythropoietin supplementation for preterm infants may reduce the rates of severe IVH (Very Low COE).

Conclusion and Relevance: Antenatal steroids and magnesium sulphate administration and early neonatal lung protective strategies reduce the rates of IVH in preterm neonates. Adequately powered RCTs evaluating IVH care bundles with long-term follow up are required.