Development of a small baby unit to improve outcomes for the extremely premature infant

Abstract

Survival and outcomes for extremely premature (EP) infants have improved and even infants born at 23 and 24 weeks that were previously considered non-viable are now routinely surviving. This review describes our particular institution's basis for and process of creating and sustaining a small baby program for a quaternary, referral-based neonatal intensive care unit. Through multidisciplinary collaboration, small baby guidelines were developed that established uniform care and optimized evidence-based practice for the care of this unique patient population. A focus on parent-centered care while removing noxious stimuli for the patient has improved neurodevelopmental outcomes. Data collection, quality improvement, and ongoing research are incorporated in the small baby program to establish and sustain best practices and outcomes for the EP patient. Through the establishment of a small baby unit, we have improved survival, decreased short-term morbidities, and improved neurodevelopmental outcomes for the EP infant in our region.

Developmental Observer

“…A more formalized approach to KMC may strengthen staff habits to consider KMC as a standard care treatment. (3 (2-5) vs. 1 (1)(2)(3), p = 0.03), and higher mean +/-SD maternal anxiety (state-trait anxiety inventory) score (39.1 +/-10.4 vs. 31.5 +/-7.3, p = 0.04) were documented in SSC combined with maternal singing during MT, as compared to SSC alone. A unique MT intervention should be designed for preterm infants with severe brain injury and their mothers.…”

“…The birth rate for South Africa in 2020 was 19.995 births per 1000 people (Macrotrends, 2021), (1,171,219 births in total for the year 2019) (Department, 2019). In South Africa the preterm birth rate was 12.4% in 2014 representing one out of every ten births (Chawanpaiboon et al, 2019).…”

Quality Improvement Initiative in the NICU for Improved Practice of Cuff Blood Pressure Measurements

“…In these patients, we have seen that this leads to significant improvements in survival without bronchopulmonary dysplasia, survival without severe intraventricular hemorrhage, and reduced lengths of stay. 15 Common practice within the NCH Neonatal Network is to obtain a cuff BP measurement every 3 to 6 hours. Excessive BP measurements should be considered painful and noxious stimuli in the NICU.…”

Survival of Extremely-Low-Birth-Weight Neonates in India

“…2. Setting up small baby units (SBU) with dedicated human resources has been associated with improved survival [6]. In large perinatal centers, a NICU may have diverse admissions, including cases of birth asphyxia, sepsis, and congenital malformations needing surgery.…”