Management Practices for Hemodynamic Impairment in Neonates Born Prematurely: A Quality Improvement Project

Area of Science:

• Neonatology
• Pediatric Cardiology
• Critical Care Medicine

Background:

• Hemodynamic impairment management in very premature neonates lacks a standardized approach.
• Current protocols in level 3 NICUs involve crystalloid infusion, followed by cardiac ultrasound and potential vasopressor use if initial treatment fails.
• A plan-do-study-act (PDSA) cycle was employed to evaluate an existing management protocol.

Purpose of the Study:

• To assess the effectiveness and adherence to a specific hemodynamic management protocol for very premature neonates (26-31 weeks gestation).
• To identify factors influencing compliance with the established protocol.
• To evaluate the impact of ultrasound-guided therapy on hemodynamic stability.

Main Methods:

• Retrospective data collection from patient records of neonates managed for hemodynamic impairment within 24 hours of birth.
• Inclusion criteria: neonates born between 26 and 31 completed weeks of gestation.
• Analysis focused on protocol adherence, reasons for non-compliance, and correlation with clinical parameters.

Main Results:

• Only 8 out of 68 eligible neonates (born from 604 total) fully complied with the protocol.
• Key reasons for non-compliance included lack of cardiac ultrasound availability and inconsistent fluid administration (duration and dosage).
• A significant correlation was observed between blood pressure, positive inspiratory pressure, and protocol compliance.

Conclusions:

• Ultrasound-guided therapy demonstrated positive responses in all neonates who received it, underscoring its therapeutic value.
• Protocol revision is recommended to emphasize echocardiography assessment for managing hemodynamic impairment.
• Enhanced training for neonatologists on protocol adherence is crucial for quality improvement in neonatal care.