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Increasing Exclusive Nursery Care of Late Preterm and Low Birth Weight Infants
Rakhi Gupta Basuray1,2, Carrie Cacioppo1,2, Vanessa Inuzuka3
1Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio.
Insights
Quality improvement initiatives increased exclusive nursery care for late preterm (LPT) and low birth weight (LBW) infants. This led to a reduction in neonatal hypoglycemia without adverse effects, preserving the mother-infant dyad.
Area of Science:
- Neonatal care
- Quality improvement science
- Pediatric nutrition
Background:
- Late preterm (LPT) and low birth weight (LBW) infants face increased NICU admission risk, often due to feeding issues.
- Exclusive nursery care aims to improve outcomes for these vulnerable infant populations.
Purpose of the Study:
- To enhance the percentage of LPT and LBW infants receiving exclusive nursery care.
- To implement quality improvement methodologies to achieve this goal.
Main Methods:
- A multidisciplinary team implemented interventions including feeding protocols, education, and care standardization.
- Statistical process control charts tracked outcomes for 1336 infants (35-36 weeks GA and term infants <2500g).
- Primary outcome: percentage of infants in exclusive nursery care. Secondary outcomes: hypoglycemia, phototherapy, weight loss, exclusive breastfeeding, length of stay.
Main Results:
- Exclusive nursery care increased from 83.9% to 88.8% post-intervention.
- Neonatal hypoglycemia rates decreased from 51.7% to 45.1%.
- No significant changes were observed in phototherapy, weight loss, exclusive breast milk feeding, or length of stay.
Conclusions:
- Nursery feeding protocols, education, and care standardization successfully increased exclusive nursery care by 4.9% and reduced neonatal hypoglycemia by 6.6%.
- These interventions preserved the mother-infant dyad through high-value care without adverse effects.
- Quality improvement initiatives are effective in optimizing care for LPT and LBW infants.
Background And Objective:
Late preterm (LPT) and low birth weight (LBW) infants are populations at increased risk for NICU admission, partly due to feeding-related conditions. This study was aimed to increase the percentage of LPT and LBW infants receiving exclusive nursery care using quality improvement methodologies.
Methods:
A multidisciplinary team implemented interventions at a single academic center. Included infants were 35 to 36 weeks gestational age and term infants with birth weights <2500 g admitted from the delivery room to the nursery. Drivers of change included feeding protocol, knowledge, and care standardization. We used statistical process control charts to track data over time. The primary outcome was the percentage of infants receiving exclusive nursery care. Secondary outcomes included rates of hypoglycemia, phototherapy, and average weight loss. Balancing measures were exclusive breast milk feeding rates and length of stay.
Results:
Included infants totaled 1336. The percentage of LPT and LBW infants receiving exclusive nursery care increased from 83.9% to 88.8% with special cause variation starting 1 month into the postintervention period. Reduction in neonatal hypoglycemia, 51.7% to 45.1%, coincided. Among infants receiving exclusive nursery care, phototherapy, weight loss, exclusive breast milk feeding, and length of stay had no special cause variation.
Conclusions:
Interventions involving a nursery feeding protocol, knowledge, and standardization of care for LPT and LBW infants were associated with increased exclusive nursery care (4.9%) and reduced rates of neonatal hypoglycemia (6.6%) without adverse effects. This quality initiative allowed for the preservation of the mother-infant dyad using high-value care.
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