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Updated: Dec 3, 2025
Transcutaneous Microcirculatory Imaging in Preterm Neonates
Published on: December 31, 2015
Continued improvement in morbidity reduction in extremely premature infants
Joseph Kaempf1, Mindy Morris2, Eileen Steffen3
1NICU, Providence St. Vincent Medical Center, Portland, Oregon, USA joseph.kaempf@providence.org.
Insights
This quality improvement collaboration significantly reduced major morbidities in extremely premature infants. Key interventions included data sharing and evidence-based toolkits, leading to improved infant outcomes.
Area of Science:
- Neonatal intensive care
- Quality improvement science
- Perinatal medicine
Background:
- Extremely premature infants (23-27 weeks gestation) face significant risks of major morbidities.
- Long-term quality improvement collaborations are crucial for improving outcomes in this vulnerable population.
Purpose of the Study:
- To report on the progress of a long-term quality improvement collaboration focused on reducing major morbidities in extremely premature infants.
- To assess the impact of collaborative strategies on infant outcomes over two epochs.
Main Methods:
- A collaboration of 10 Vermont Oxford Network (VON) neonatal intensive care units (NICUs) utilized face-to-face meetings, teleconferences, transparent data sharing, evidence-based toolkits, family integration, and benchmarking.
- A composite mortality-morbidity score (Benefit Metric) was used to compare outcomes between 2010-2013 and 2014-2018.
Main Results:
- The collaboration's Benefit Metric significantly improved (p=0.03) and remained superior to the aggregate VON data.
- Significant improvements were observed in chronic lung disease (48%-40%), low discharge weight (32%-22%), late infection (19%-17%), and periventricular leukomalacia (4%-2%).
- In the second epoch, 34% of survivors had no major morbidities, and 36% had only one, with no significant change in mortality.
Conclusions:
- Inter-NICU collaboration, data sharing, and practice toolkits effectively sustain improvements in morbidity rates for extremely premature infants.
- The study highlights significant reductions in chronic lung disease, extrauterine growth restriction, and an increase in infants with zero or one major morbidity.
- Unmeasured biological and cultural variables present challenges in replicating these quality improvement successes in other settings.
Objective:
Provide a progress report updating our long-term quality improvement collaboration focused on major morbidity reduction in extremely premature infants 23-27 weeks.
Methods:
10 Vermont Oxford Network (VON) neonatal intensive care units (NICUs) (the POD) sustained a structured alliance: (A) face-to-face meetings, site visits and teleconferences, (B) transparent process and outcomes sharing, (C) utilisation of evidence-based potentially better practice toolkits, (D) family integration and (E) benchmarking via a composite mortality-morbidity score (Benefit Metric). Morbidity-specific toolkits were employed variably by each NICU according to local priorities. The eight major VON morbidities and the risk-adjusted Benefit Metric were compared in two epochs 2010-2013 versus 2014-2018.
Results:
5888 infants, mean (SD) gestational age 25.8 (1.4) weeks, were tracked. The POD Benefit Metric significantly improved (p=0.03) and remained superior to the aggregate VON both epochs (p<0.001). Four POD morbidities significantly improved through 2018 - chronic lung disease (48%-40%), discharge weight <10th percentile (32%-22%), any late infection (19%-17%) and periventricular leukomalacia (4%-2%). In epoch 2, 34% of survivors had none of the eight major morbidities, while 36% had just one. Mortality did not change.
Conclusions:
Inter-NICU collaboration, process and outcomes sharing and potentially better practice toolkits sustain improvement in 23-27 week morbidity rates, notably chronic lung disease, extrauterine growth restriction and the lowest zero-or-one major morbidity rate reported by a quality improvement collaboration. Unrevealed biological and cultural variables affect morbidity rates, countless remain unmeasured, thus duplication to other quality improvement groups is challenging. Understanding intensive care as innumerable interactions and constant flux that defy convenient linear constructs is fundamental.
