512 - Using statewide QI collaboration to improve neuroprotective care and outcomes for preterm infants and their families

Publication Number: 512.7096

Elizabeth E. Rogers, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Courtney C.. Breault, California Perinatal Quality Care Collaboration, Barrington, IL, United States; Xin Cui, Stanford University School of Medicine, Palo Alto, CA, United States; Jessica Liu, Stanford University School of Medicine, Palo Alto, CA, United States; Mindy Morris, Stanford University School of Medicine, Huntington Beach, CA, United States; Jennifer M. Canvasser, Necrotizing Enterocolitis (NEC) Society, Davis, CA, United States; Necole McRae, Free2Read Educational Recovery Services, SACRAMENTO, CA, United States; Roberta Pineda, University of Southern California, Altadena, CA, United States; Jochen Profit, Stanford University School of Medicine, Palo Alto, CA, United States

Background: Although survival for preterm infants has improved, long- term neurodevelopmental outcomes remain unchanged. In an attempt to improve neurodevelopmental outcomes among very low birthweight infants, the California Perinatal Quality Care Collaborative (CPQCC) sponsored a quality improvement (QI) collaborative focused on NICUs Enabling Optimal Brain Health (NEOBrain). Priorities included: 1) protection of normal brain maturation, 2) prevention of acquired injury, and 3) promotion of positive sensory experiences and relationships. The global aim of NEOBrain was to improve neuroprotective care delivery and brain health outcomes through promoting positive interactions, minimizing unnecessary interventions, and integrating families as partners. The initiative included each NICU benchmarking current practices, collecting data at the individual level across the time of the initiative, and engaging in monthly webinars and team-sharing exchange.

Objective: To increase the provision of positive touch from parents and health care providers (HCPs) as a proxy for neuroprotective care delivery for very preterm infants in the CPQCC NEOBrain collaborative.

Design/Methods: The primary metric, defined by the faculty panel prior to the collaborative, was provision of positive parental touch within 72 hours of admission and ongoing positive parental touch for at least 5 out of 7 days/week, with an important secondary outcome of HCP-provided positive touch 7 days/week until 36 weeks postmenstrual age. Outcome measures were presented using Statistical Process Control (SPC) chart for the phase of baseline (March 2022 to May 2022), active intervention (June 2022 to May 2023), and sustainability (June 2023 and May 2024).

Results: 27 neonatal units across California participated in the collaborative with 3,026 VLBW infants included in the analyses. Positive parental touch within 72 hours of birth was improved during the active intervention phase, and the improvement was sustained during the one-year post collaborative period. Parental positive touch for at least 5 out of 7 days/week was stable throughout the collaborative. Daily HCP-provided positive touch was improved during the active intervention phase and further improved during the one-year post collaborative period.

Conclusion(s): Statewide QI collaboration resulted in improved positive sensory intervention delivery to preterm infants in the NICU. Ongoing analysis of this cohort will include skin to skin care initiation and frequency, parental confidence at discharge, and long-term outcomes to assess the benefit of neuroprotective care provision on neurodevelopment.

Table
NEOBrain Table for PAS.pdfCharacteristics of participating hospitals

Figure 1
PPT figure.pdfPositive parental touch within 72 hours of birth

Figure 2
NEOBrain Figure 2 for PAS.pdfPositive parental touch at least 5 days this week (top) and Positive touch from the care team daily this week (bottom)