Extremely low gestational age infants: Developing a multidisciplinary care bundle

Area of Science:

• Neonatalogy
• Pediatrics
• Critical Care Medicine

Background:

• Limited clinical experience exists in Canada for managing extremely low gestational age infants, especially those born before 24 weeks' gestation.
• There is a need to harmonize and improve the quality of care for infants born before 26 weeks' gestation.

Purpose of the Study:

• To develop a standardized bedside care bundle for infants born <26 weeks' gestation.
• To incorporate special considerations for infants born <24 weeks' gestation.
• To improve the quality of care for extremely preterm infants.

Main Methods:

• A multidisciplinary working group was formed, drawing on expertise in preterm infant care.
• A comprehensive literature search (2000-2019) identified best practices for extremely preterm infants.
• The Plan-Do-Study-Act methodology guided iterative improvements, incorporating Canadian and international consultations.

Main Results:

• A care bundle was implemented in October 2015, structured into three time periods (resuscitation, first 72 hours, days 4-7) with multiple care themes.
• Key practice changes focused on improving skin integrity, admission temperature, feeding initiation, transcutaneous CO2 monitoring, and ventilation.
• Between implementation and end of 2019, 127 infants <26 weeks gestation were admitted, with 78 surviving to discharge (61% survival rate).

Conclusions:

• Ongoing auditing and evaluation are necessary to determine the care bundle's impact on short- and long-term outcomes.
• The developed care bundle and the experience gained may serve as a valuable resource for other centers managing extremely low gestational age infants.