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Quality Improvement Project

Program: Section on Neonatal-Perinatal Medicine

P2C025: Increasing the Rate of Infants Rooming in with Their Mothers with Low-acuity Congenital Heart Disease

Saturday, October 21, 2023
12:00 PM – 1:30 PM US EDT
Location: Walter E. Washington Convention Center, Exhibit Hall A
Poster Presentation
Purpose/Objectives: Purpose/Objectives
The Children’s Mercy Fetal Health Center (FHC) was created to deliver infants with complex fetal diagnoses including congenital heart disease. Mothers are referred from all over the Midwest for their babies to have access to specialized care immediately after birth. Nearly all babies born in the FHC are admitted to our neonatal intensive care unit (NICU), as there are not well-established guidelines for keeping babies with their mothers if they have low-risk congenital heart disease. Maternal infant bonding is important to help establish breastfeeding and for early childhood development. Previously, only 25% of patients with these diagnoses that would have been safe to room in with their mothers did. We aim to increase the rate of neonates born with low acuity congenital heart disease that room-in with their mothers in the FHC from 25% to 45% by December 2023.

Design/Methods: Design/Methods
We utilized a fishbone diagram and 5 why’s to investigate the barriers to infants rooming in with their mothers. Guidelines were developed in collaboration with Pediatric Cardiologists to help providers assess the appropriateness of allowing a patient to room in with the mother with intermittent monitoring of vital signs. Education was provided to the unit, including physicians, NNPs and nurses about implementing the protocol. A run chart was utilized to monitor and collect data.

Results: Results
Three infants have qualified as low acuity since the initiation of our protocol. Two of these infants successfully returned to their mother’s room. These two patients initially required monitoring in the NICU for a short period of time then deemed safe to room-in by the Neonatology and Cardiology Teams. These infants were then safely discharged without complications.

Conclusion/Discussion: Conclusion/Discussion
Neonates with low-acuity congenital heart disease can safely room-in with their mothers in the Children's Mercy Fetal Health Center. It is impossible to know at delivery how a neonate will transition to post-natal life, limiting our ability to guarantee every patient will be able to room-in. The next PDSA cycle will include implementing discussion of patients’ ability to room-in at the weekly FHC patient meeting.