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Improving Survival in the 22-24 Weeks Gestation Newborn: A Single-center Quality Improvement Initiative
William Frank Liu1,2, Harshit Doshi3
1Golisano Children's Hospital of Southwest Florida, Section of Neonatology, Florida, United States, Fort Myers.
Objective:
To review the impact of a quality improvement initiative upon survival and key in-house morbidities.
Study Design:
A prospective cohort with retrospective baseline, quality improvement initiative, with key drivers for improvement focused on perinatal, delivery room, and neonatal care management, comparing 2016 to 2019 (baseline) and 2020 to 2023 (intervention).
Results:
Survival rates (discharge to home) improved at 22 weeks (14.3%, 71.4%; p = 0.002), and at 22 to 24 weeks (60.2%, 76.9%; p = 0.018). At 22 to 24 weeks 1- and 5-minute Apgar scores (2 [1-4], 3 [2-5]; p = 0.031) improved. At 22 weeks, there was an increase in use of post-natal steroids (11.1%, 63.2%; p = 0.016). At 22 to 24 weeks, there was an increase in the placement of a gastrostomy tube (9.1%, 20.2%; p = 0.045) and tracheostomy tube (0%, 9%; p = 0.008).
Conclusion:
A single-center experience implementing a quality improvement initiative that employed active management, and updating our standardized care guidelines, demonstrated improved survival rates at 22 weeks and combined 22 to 24 weeks gestation. Key morbidities remain high and unchanged, with an increased need for gastrostomy and tracheostomy tube placement.
Key Points:
· Factors for survival at 22 to 24 weeks includes active management at 22-weeks gestation, and a culture of team building.. · Evidence-based guidelines remains limited for this gestational age population.. · Standardized clinical practices with consistent implementation may contribute to improved outcomes..
