Improving delivery room and admission efficiency and outcomes for infants < 32 weeks: ELGAN+ (Extremely Low...

Area of Science:

• Neonatal care
• Perinatal medicine
• Clinical quality improvement

Background:

• Infants born before 32 weeks gestation require specialized, coordinated care from delivery through neonatal intensive care.
• Existing care pathways may lack systematic organization, potentially impacting efficiency and clinical outcomes.
• Improving the transition from delivery room to neonatal intensive care unit (NICU) is crucial for vulnerable preterm infants.

Purpose of the Study:

• To implement and evaluate a systematic approach for the resuscitation, stabilization, and admission of preterm infants (<32 weeks gestation).
• To assess the impact of this systematic approach on organizational efficiency and clinical outcomes during hospitalization.
• To enhance the care pathway for extremely preterm infants.

Main Methods:

• Retrospective study design comparing a pre-implementation period (controls) with a post-implementation period (cases).
• Implementation involved a multidisciplinary team utilizing checklists, defined roles, organized equipment, a step-by-step protocol, and real-time documentation.
• Data collected for infants <32 weeks gestation from delivery room to NICU admission over two 2-year periods (2015-2019).

Main Results:

• The systematic approach led to increased surfactant use (41% vs. 27%) and reduced time to surfactant administration (median 34 vs. 74 minutes).
• Observed reductions in bronchopulmonary dysplasia, intraventricular hemorrhage, severe retinopathy of prematurity, and necrotizing enterocolitis.
• While trends favored the intervention group, statistical significance for reduced comorbidities was not achieved after adjusting for illness severity.

Conclusions:

• A systematic, multidisciplinary approach significantly improved care delivery for preterm infants (<32 weeks gestation).
• The structured protocol enhanced key aspects of immediate postnatal care, including surfactant administration.
• The study demonstrated a positive impact on mortality rates and a trend towards reduced comorbidities in this vulnerable population.