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Improving growth of very low birth weight infants in the first 28 days
Barry T Bloom1, John Mulligan, Cody Arnold
1Wesley Medical Center, Wichita, Kansas 67214-4976, USA. barrybloom@aol.com
Insights
Improving infant weight gain in very low birth weight (VLBW) neonates is achievable by identifying and sharing best practices. Sharing these process differences enhanced weight gain in VLBW infants across a neonatal network.
Area of Science:
- Neonatal care
- Pediatric growth and development
- Quality improvement in healthcare
Background:
- Very low birth weight (VLBW) infants often experience suboptimal weight gain, impacting their long-term health outcomes.
- Variability in clinical processes across neonatal centers can contribute to disparities in infant growth.
- Standardizing and optimizing care pathways is crucial for improving VLBW infant outcomes.
Purpose of the Study:
- To enhance weight gain in very low birth weight (VLBW) infants within the first 28 days post-birth.
- To identify and disseminate significant process variations between high- and low-weight-gain centers in a neonatal network.
- To leverage quality improvement strategies to achieve better growth outcomes for VLBW infants.
Main Methods:
- A national network of neonatologists identified average weight gain in the first 28 days as a key performance indicator.
- A structured observation guide was developed to assess processes influencing infant growth at high- and low-performing centers.
- Data from 1997-1999 were analyzed to identify 16 meaningful differences in processes between centers with high and low weight gain.
Main Results:
- Average daily weight gain for VLBW infants increased from 10.4 g in 1999 to 12.5 g in 2001.
- 76% of participating units showed improvement in infant weight gain following the intervention.
- No significant differences in mortality or major morbidities were observed, despite improved weight gain.
Conclusions:
- Disseminating identified best practices and process improvements can significantly enhance clinical outcomes, such as infant weight gain.
- Variations in common clinical processes directly influence patient outcomes.
- Targeted quality improvement initiatives focusing on process standardization can accelerate improvements in neonatal care.
Objective:
To increase weight gain in the first 28 days after birth for very low birth weight (VLBW) infants by isolating and sharing meaningful process differences between high- and low-weight-gain centers within a neonatal network.
Design/Methods:
We identified weight gain as an important target for improvement in 1999 for our national group practice of neonatologists. Site-specific average weight gain during the first 28 days was the primary outcome measure. Our target population was defined as inborn infants who survived and remained in the hospital of birth, whose birth weights were between 401 and 1500 g (VLBW), and who were >22 weeks' estimated gestational age. A team of 6 neonatologists and 1 nurse met, reviewed processes that might influence growth, and developed a structured observation guide for site visits. Weight gain data were obtained from an existing administrative database for the period January 1, 1997, through June 30, 1999. Centers were ranked and divided into upper, middle, and lower thirds. Seven team members visited 1 high- and 1 low-weight-gain center without being informed of the center's performance. Following the site visits, the team isolated 16 meaningful differences between high- and low-weight-gain sites. Meaningful differences were defined as processes observed in all or virtually all (for this project, 6 or 7 of 7 centers) of the high and none or virtually none (for this project, 0 or 1 of 7) of the low centers. The meaningful differences were distributed to our medical directors in August 2000 along with their site-specific weight-gain performance. To document the impact of sharing this material, we compared weight gain in a baseline period of January 1 through December 31, 1999 and a posteducational intervention period of January 1 through September 30, 2001.
Results:
Compared with neonates admitted to our national neonatal practice in 1999, neonates admitted in 2001 were similar in birth weight, gestational age at birth, exposure to antenatal steroids, and male gender. Average daily weight gain during the first 28 days increased from 10.4 +/- 6 g for neonates cared for in 1999 to 12.5 +/- 6 g for neonates cared for in 2001. Thirty-nine of 51 (76%) units noted improvements, 4 were unchanged and 8 noted a decrease in average weight gain. Despite similar average lengths of stay, the average discharge weight for neonates sent home increased from 2.15 +/- 0.5 kg for 1999 to 2.29 +/- 0.5 kg for 2001. There were no differences in frequencies of mortality or major morbidities, including severe intraventricular hemorrhage, retinopathy, or necrotizing enterocolitis, between the 2 time periods. An increase in the use of continuous positive airway pressure was noted in the post implementation period.
Conclusions:
Variation in common processes can alter clinical outcomes. Although temporal trends in weight gain may be, in part, responsible for this trend, it appears that isolation and implementation of meaningful differences in processes can augment our desire to rapidly improve clinical outcomes.
