Improved growth and decreased morbidities in &lt;1000 g neonates after early management changes

Geary, Cara; Fonseca, Rafael; Caskey, Melinda; Malloy, Michael H.

doi:10.1038/jp.2008.15

Cited by 22 publications

(17 citation statements)

References 38 publications

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“…[17][18][19] All checklists and guidelines were developed based on evidence and with the NICU's current culture and practice in mind. Simply developing a tool without an effort to pair the tool with a change in approach, training, and removal of barriers is less likely to change practice.…”

Section: Figurementioning

confidence: 99%

Small Baby Unit Improves Quality and Outcomes in Extremely Low Birth Weight Infants

2015

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The survival rates for extremely low birth weight (ELBW) infants have improved, but many are discharged from the hospital with significant challenges. Our goal was to improve outcomes for this population by using a multidisciplinary team-based quality improvement approach. METHODS:A unique program called the Small Baby Unit (SBU) was established in a children's hospital to care for the ELBW infant born at 28 weeks or less and weighing less than 1000 g at birth. These patients were cared for in a separate location from the main neonatal unit. A core multidisciplinary team that participates in ongoing educational and process-improvement collaboration provides care. Evidence-based guidelines and checklists standardized the approach.RESULTS: Data from the 2 years before and 4 years after opening the SBU are included. There was a reduction in chronic lung disease from 47.5% to 35.4% (P = .097). The rate of hospital-acquired infection decreased from 39.3% to 19.4% (P , .001). Infants being discharged with growth restriction (combined weight and head circumference ,10th percentile) decreased from 62.3% to 37.3% (P = .001). Reduced resource utilization was demonstrated as the mean number per patient of laboratory tests decreased from 224 to 82 (P , .001) and radiographs decreased from 45 to 22 (P , .001).CONCLUSIONS: Care in a distinct unit by a consistent multidisciplinary SBU team using quality improvement methods improved outcomes in ELBW infants. Ongoing team engagement and development are required to sustain improved outcomes.Progress in the care of preterm newborns has gradually moved from what we do (new medications and devices) to how we do it. Although the survival rate of extremely low birth weight (ELBW) infants has improved with advances in neonatal intensive care, many survivors are discharged from the hospital with neurodevelopmental delays and/or chronic medical problems. 1 Significant variation in outcomes among NICUs has been documented. [2][3][4] Practice variation among providers at the same institution also complicates care. 5,6 Collaborative quality improvement (QI) and team-based care has been shown to significantly improve outcomes. [7][8][9][10] Outcomes for the ELBW population in the study NICU demonstrated average performance compared with national benchmarks. We hypothesized that we could improve outcomes including a reduction in chronic lung disease (CLD), a major ELBW morbidity, with a QI initiative that changed our practice model by establishing a separate unit and specialized team to care for these infants. We further hypothesized that

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Section: Figurementioning

confidence: 99%

Small Baby Unit Improves Quality and Outcomes in Extremely Low Birth Weight Infants

2015

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“…En France, les décrets de périnatalité de 1998 y ont contribué ; des stratégies thérapeutiques avec un recours plus systématique aux traitements efficaces, moins systéma-tique aux techniques les plus invasives (ventilation conventionnelle, oxygénothérapie intensive) ; elles ont permis de réduire la morbidité respiratoire secondaire et la durée d'hospitalisation en réanimation [45]. Cela comprend aussi la diffusion de nouvelles pratiques nutritionnelles qui visent à réduire des complications néonatales graves (entérocolite ulcéronécrosante) et favoriser une croissance pondérale rapide [46]. Certains protocoles concernant l'utilisation du lait de mère, l'introduction de la nutrition entérale et la supplémentation en probiotiques (compléments alimentaires contenant des bactéries vivantes en vue d'améliorer l'équilibre de la flore intestinale) ont été évalués par des essais randomisés.…”

Section: éVolution Des Pratiques Et Prévention Des Conséquences De Launclassified

Le point sur la prématurité en 2009

Ancel

2009

Rev. med. perinat.

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La prématurité concerne près de 12-13 % des naissances aux États-Unis et 5-7 % dans les pays européens. En France, près de 40 000 (5 %) surviennent entre 33 et 36 semaines et 10 000 (1,2 %) avant 33 semaines. Les progrès accomplis ont permis d'améliorer la survie des enfants prématurés et grands prématurés. Cette évolution a soulevé des questions sur le devenir à long terme de cette population. Le risque de déficiences motrices, sensorielles et surtout cognitives est élevé chez les grands prématurés, mais des études récentes ont montré que la morbidité était également importante à 33-36 SA. Par conséquent, un suivi rapproché des enfants prématurés en vue de détecter et prendre en charge les troubles du développement reste nécessaire. L'amélioration des pratiques préventives suppose aussi la mise en oeuvre de travaux de recherche sur les mécanismes en cause dans la survenue des accouchements prématurés autant que sur leurs conséquences à court et moyen termes.Mots clés Prématurité · Survie · Devenir à long terme · Pratiques médicales · Étiologie Abstract The frequency of preterm birth is about 12-13% in the USA and 5-7% in European countries. In France, almost 40,000 births (5%) occur between 33 and 36 weeks and 10,000 (1.2%) at less than 33 weeks. The number of neonates surviving preterm or very preterm has increased because of progress in therapy and quality of care. However, this increasing survival raised issues about adverse neurodevelopmental outcome. The risk of motor, sensorineural and cognitive impairments is very high among very preterm children, but recent studies reported that neonates born at 33-36 weeks experienced substantial morbidity and often required admission in neonatal intensive care units. Thus, all preterm infants should be carefully monitored to ensure prompt detection and management of neurodevelopmental impairments. Additional research exploring pathophysiology of preterm birth and its consequences is obviously needed, which will hopefully lead to the development of new therapeutic approaches.

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“…The beginning of the decade from 1990 to 2000 saw the introduction of surfactant and consensus building for the use of antenatal steroids 7,8,9 and in the second decade from 2000 to 2010, the refinement of ventilation strategies and improved nutrition. 10,11 METHODS US-linked infant birth and death certificate period files were downloaded from the National Center for Health Statistics for the years 1990, 2000 and 2010. 12 Maternal demographic, pregnancy, labor and delivery characteristics and infant birth characteristics were extracted from the files.…”

Section: Introductionmentioning

confidence: 99%

Changes in infant mortality among extremely preterm infants: US vital statistics data 1990 vs 2000 vs 2010

Malloy

2015

J Perinatol

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Improved growth and decreased morbidities in <1000 g neonates after early management changes

Cited by 22 publications

References 38 publications

Small Baby Unit Improves Quality and Outcomes in Extremely Low Birth Weight Infants

Small Baby Unit Improves Quality and Outcomes in Extremely Low Birth Weight Infants

Le point sur la prématurité en 2009

Changes in infant mortality among extremely preterm infants: US vital statistics data 1990 vs 2000 vs 2010

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