P2C063: Early Experience with Launch of a Small Baby Program

Purpose/Objectives: Dedicated small baby units have been shown to improve outcomes in extremely preterm infants including lower rates of intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia. We launched a small baby program (SBP) in January 2022, after a 3-month comprehensive educational and training program with focus on three key drivers including a highly specialized and dedicated multidisciplinary team, location and delivery of evidence-based care and best practices consistently in infants born below 27 weeks gestational age. We implemented several care bundles including delivery room checklists, golden hour practices, neuroprotection, respiratory, patent ductus arteriosus, antibiotic stewardship guidelines as secondary drivers and process measures as depicted in the Key driver diagram (Figure 1). The overall objective of the SBP was to improve survival without major morbidities, Within the program we implemented neuroprotective care bundle with a specific objective to reduce severe intraventricular hemorrhage (IVH) by 50% in 12 months from a baseline rate of any IVH of 55% and severe IVH of 18.4% in 2021.

Design/Methods: As a part of a quality improvement initiative, we prospectively collected data on maternal, infant characteristics, process and outcome measures. Data on process and outcome measures over the 12 months since implementation of SBP are described. A statistical process chart (SPC) was used to analyze rates of severe IVH over the period of 12 months.

Results: A total of 44 infants were admitted to the small baby unit. Mean gestational age was 24.75 (+/- 1.5) weeks with 23 (52%) infants born below 25 weeks. Mean birth weight was 640 grams (+/- 170 grams) with 10 (22%) infants born with birthweight below 500 grams. Overall survival was 75%. Rates of any IVH was 34% and severe IVH was 11.7%. All severe IVH occurred in the first 6 months with a shift seen in June 2022 on the SPC chart (Figure 2). 9% of the infants had necrotizing enterocolitis or spontaneous intestinal perforation. Two infants had central line associated blood stream infections (CLABSI) in the first six months and no CLABSI reported in second six months. BPD occurred in 78% of infants, and 11% developed severe ROP. 80% of infants discharged home had weight, length and head circumference above the 10th percentile.

Conclusion/Discussion: We describe our outcomes for the first year since implementation of the small baby program. Rates of any IVH and severe IVH were noted to be lower than baseline rate with no severe IVH and CLABSI noted in the second six months. The majority of infants discharged home had growth parameters above 10th centiles. Whilst initial results are encouraging, continued monitoring of process and outcomes measures are needed to evaluate the long-term impact of the small baby program.