389 - Standardization of Care Improves Survival in Extremely Preterm Infants

Publication Number: 389.6795

P Sireesha. Nandula, University of Florida College of Medicine, Jacksonville, FL, United States; Sanket D. Shah, University of Florida College of Medicine, Jackonsville, FL, United States; Mohammad Adawi, University of Florida College of Medicine, Jacksonville, FL, United States; Molly Southard, Wolfson Children's Hospital, Jacksonville, FL, United States; Shiva Gautam, University of Florida College of Medicine, Jacksonville, FL, United States; Vasantha HS. Kumar, University of Florida College of Medicine, Jacksonville, Jacksonville, FL, United States

Background: Extremely premature infants (EPI) born before 28 weeks gestational age are at higher risk of morbidity and mortality. An increasing number of neonatal ICUs have initiated “Small Baby” (SBU) programs to optimize care and improve short-term and long-term outcomes in this population. SBUs, by adopting consensus-based guidelines and potentially best practices, improve both the quality and care of EPI.

Objective: To compare survival and short-term clinical outcomes before and after establishing a small baby Unit at a level 4 NICU in extremely premature infants.

Design/Methods: We studied infants born < 28 weeks gestation and admitted to the NICU, Wolfson Children’s Hospital, Jacksonville, FL. The pre-SBU cohort included infants born between 06/2020 and 05/2022; and the SBU cohort included infants born between 06/2022 and 06/2024. We excluded infants who died within 72 hours of age. We initiated the SBU program and admitted eligible EPI to the designated location in June 2022. Evidence-based guidelines and potentially best practices were implemented as part of the SBU program. A multidisciplinary SBU committee was created to supervise clinical outcomes in SBU. Patient characteristics and clinical outcomes were compared between the pre-SBU and the SBU groups. Analysis was performed using parametric and non-parametric tests as appropriate. Logistic regression was done to assess the effect of gestational age on survival.

Results: Of the 215 eligible infants, 103 infants were enrolled in the pre-SBU cohort and 112 in the SBU cohort. Baseline characteristics (Table 1) and short-term clinical outcomes (Table 2) were mostly similar between the survivors in the two cohorts. Mortality remained similar between the two cohorts, with 15.5% (16/103) in the pre-SBU cohort compared to 17.8% (20/113) in the SBU cohort. Among survivors, median gestational age (GA) was significantly lower in the SBU cohort compared to the pre-SBU cohort (25 weeks vs 26 weeks; p=0.01, Table 1). Regression analysis demonstrated a 45% increase in survival every week in the SBU group after adjusting for GA (p- 0.002, OR- 1.455; CI:1.14-1.85).

Conclusion(s): Our study demonstrated that survival significantly improved at lower gestational ages in the SBU cohort. The development of the SBU program and standardization of care improves survival at lower gestational age in EPI.

Table 1: Demographic Characteristics in Extremely Preterm Infants Who Survived
Results are demonstrated as median with interquartile range. P values are from Wilcoxon rank sum test. Gender was evaluated with Fisher's exact test.

Table 2: Short-term Clinical Outcomes in Extremely Premature Infant Survivors in Pre- SBU and SBU cohorts
Fisher exact test was used to analyze NEC, Severe IVH, Pneumothorax. Chi- Square test was used to analyze BPD and Sepsis.