Assistant professor University of South Alabama Mobile, Alabama, United States
Background: Despite improvements in the care of extremely preterm infants (EP) infants, high neonatal morbidity and mortality rates remain a significant concern. Developing a dedicated team and unit for EP within the neonatal intensive care unit (NICU) could potentially reduce the variance in practice and improve outcomes. However, evidence is limited on whether a dedicated unit would benefit EP infants. We established a designated multidisciplinary team assigned to a small baby unit (SBU) located in the neonatal intensive care unit (NICU) in July 2019 to improve outcomes in ≤ 28 weeks gestation infants. Objective: To assess the impact of implementing a small baby unit/team on neonatal mortality and morbidity in ≤ 28 weeks gestation infants. Design/Methods: In this retrospective study, we compared neonatal mortality and morbidities of ≤ 28 weeks gestation infants who were cared for by the SBU team (intervention group, born from Jan 2020-Jan 2022) and those who were managed by a larger pool of nurses (control group, born Jan 2016 – Dec 2018). Results: We included 658 infants (332 in the control group and 326 in the intervention group). While both groups have similar gestational age and birth weight, infants born in the intervention group have higher rates of depressed Apgar scores (scores ≤3 at 1 and 5 mins) and intubation in the delivery room. Among common neonatal morbidities, BPD rate was reduced in the intervention group compared to the control group (50% vs. 59%, p=0.02). There was no change in the rate of severe IVH despite lower rates of indomethacin use for neuro-prophylaxis in the intervention group compared to the control group (68% vs. 92%, p< 0.01). There was no significant difference in neonatal mortality and other in-hospital morbidity. Hypothermia during admission period was reduced in the intervention group compared to the control group (50% vs. 68%, p< 0.01).
Conclusion(s): Our data demonstrate that consistent care by a small baby team in a distinct unit decreases hypothermia during admission period and BPD. Ongoing team engagement and development are required to sustain these improved outcomes.
