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A Quality Improvement Project to Increase Frequency of Skin-to-Skin Contact for Extreme Low-Birth-Weight Infants in
Helen Nation1, Lauren Sanlorenzo, Kiersten Lebar
1Duke University, Durham, North Carolina, and Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee (Dr Nation); Division of Neonatology, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee (Dr Sanlorenzo); Women's and Children's Service Line, Philadelphia, Pennsylvania (Dr Lebar); and Duke University School of Nursing, Durham, North Carolina (Dr Brandon).
Insights
Skin-to-skin contact (SSC) significantly increased for extremely preterm infants by implementing a new protocol and education. This initiative improved nursing comfort and SSC rates, even for medically complex neonates.
Area of Science:
- Neonatalogy
- Pediatrics
- Quality Improvement
Background:
- Skin-to-skin contact (SSC) benefits are known but underutilized in extremely preterm infants due to medical complexity and staff concerns.
- Barriers to SSC in this population include nursing misconceptions about safety and protocol limitations.
Purpose of the Study:
- To increase skin-to-skin contact (SSC) utilization in infants born before 29 weeks' gestation.
- To address and overcome nursing barriers inhibiting SSC in the neonatal intensive care unit (NICU).
Main Methods:
- A quality improvement initiative involving a pre-/postsurvey to assess nursing comfort and perceived barriers.
- Implementation of an updated unit-specific SSC protocol and tailored education addressing identified barriers.
- Evaluation of SSC rates and maternal human milk usage in the first 30 days for 81 infants (22-28 weeks gestation).
Main Results:
- SSC rates increased from 3.3%-17.7% at baseline to 33.2%-39.1% postintervention.
- Maternal human milk utilization exceeded the 75% target on days 7 and 14, though it declined by days 21 and 30.
- Nursing comfort significantly increased for performing SSC on intubated infants and those with central lines, correlating with higher SSC rates.
Conclusions:
- A targeted quality improvement initiative can successfully increase SSC rates in extremely preterm infants.
- Addressing nursing barriers through protocol updates and education enhances comfort and utilization of SSC, even in complex neonates.
- While SSC rates improved, sustained maternal human milk usage requires further investigation.
Abstract:
Benefits of skin-to-skin contact (SSC) are documented but often delayed in the extremely preterm population due to medical complexity and staff misconceptions about safety. This quality improvement initiative was designed to increase SSC utilization among infants born before 29 weeks' gestation regardless of respiratory support by addressing nursing barriers inhibiting SSC. A pre-/postsurvey evaluated comfort level performing and perceived barriers to SSC utilization. Implementation consisted of an updated unit-specific SSC protocol and tailored education specific to identified barriers. Evaluation included SSC rates and maternal human milk usage in the first 30 days of life. In total, 81 patients (22-28 weeks, 370-1410 g) were included. SSC rates ranged from 3.3% to 17.7% at baseline and increased to 33.2% to 39.1% postintervention. Maternal human milk utilization increased above target (≥75%) postintervention for days 7 and 14, but declined towards baseline on days 21 and 30. A statistically significant increase was observed in nursing comfort level when performing SSC for intubated infants as well as infants with a peripherally inserted central catheter or umbilical venous catheter. SSC rates increased with infants younger than 29 weeks requiring intubation and central line management, possibly as a result of greater nursing comfort surrounding with SSC.
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