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Extremely low gestational age infants: Developing a multidisciplinary care bundle.

Emanuela Ferretti1,2, Thierry Daboval1,2, Nicole Rouvinez-Bouali1,2

  • 1Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Ontario.

Paediatrics & Child Health
|October 11, 2021
PubMed
Summary
This summary is machine-generated.

A new bedside care bundle was developed for extremely preterm infants (<26 weeks gestation) in Canada. This approach aims to standardize and enhance care quality for these vulnerable newborns, with a survival rate of 61% observed.

Keywords:
Care bundleExtremely low gestational ageNeonateQuality improvement

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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.