Quality improvement project designed to reduce disproportionate growth in extremely low gestational age neonates:...

Area of Science:

• Neonatalogy
• Developmental Pediatrics
• Quality Improvement Science

Background:

• Very preterm infants (23-28 weeks gestational age) often experience growth challenges.
• Discharge anthropometrics, including weight-for-length, are critical indicators of infant health.
• Cognitive development in preterm infants is a key outcome measure.

Purpose of the Study:

• To evaluate the impact of a quality improvement (QI) project on cognitive outcomes in very preterm infants.
• To determine if reducing discharge Z-scores for weight, BMI, and weight-for-length affected cognitive scores.
• To assess changes in Bayley-III cognitive scores before and after QI implementation.

Main Methods:

• A single-institution QI project was implemented to decrease discharge Z-scores for weight, BMI, and weight-for-length.
• Bayley-III cognitive assessments were compared at ≥18 months corrected age between infants before (Epoch-1) and after (Epoch-2) QI implementation.
• Statistical analysis compared the frequency and median cognitive scores between the two epochs.

Main Results:

• Bayley testing was available for 86% of infants in Epoch-1 and 79% in Epoch-2.
• There was no significant change in the frequency of low (<85) cognitive scores (p=0.5).
• Median cognitive scores did not differ significantly between epochs (80 vs. 85, p=0.35), and adjusted odds of low cognitive scores remained unchanged.

Conclusions:

• Implementing a QI project to reduce discharge weight-for-length disproportion did not alter cognitive outcomes at ≥18 months corrected age in very preterm infants.
• The findings suggest that interventions targeting specific anthropometric measures at discharge may not directly translate to improved cognitive development in this population.
• Further research may be needed to identify effective strategies for enhancing neurodevelopmental outcomes in very preterm infants.