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Evidence-based guidelines can improve outcomes in very preterm infants

Monday September 23, 2013
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Using a set of evidence-based guidelines in the delivery room can improve outcomes for low-birth weight preterm infants, according to a recent journal article.

The guidelines, developed by nurses, physicians and a respiratory therapist at the Children’s Hospital of Philadelphia and the University of Pennsylvania Hospital, also in Philadelphia, focused on preventing heat loss, reducing exposure to supplemental oxygen and increasing use of noninvasive respiratory support for infants weighing less than 43.75 ounces at birth.

The article, which includes their study, was published Sept. 16 on the website of the journal Pediatrics.

Researchers relied on multidisciplinary conferences, a checklist, an appointed dedicated resuscitation nurse and frequent feedback for clinicians to implement the evidence-based guidelines. They then compared a group of 80 patients from before the implementation to a similar group of 80 patients after the guidelines took effect. The researchers tracked infants’ axillary temperatures when they were admitted to the intensive care nursery, while also observing adherence to the guidelines and clinically relevant patient outcomes.

They found average NICU admission temperatures increased to 98.06 F after introducing the guidelines, compared with an average of 97.52 F before the guidelines. The percentage of infants admitted with moderate or severe hypothermia also dropped after adoption of the guidelines, from 14% to 1%. Newborns also were exposed to less supplemental oxygen during the first 10 minutes but had similar oxygen saturations, according to the findings.

Although more infants were tried on continuous positive airway pressure after guideline adoption (61% versus 40%), the rate of intubation was not statistically different. After the initiative, the median duration of invasive ventilation and hospitalization decreased from five days to one day and from 80 days to 60 days, respectively.

“We have demonstrated significantly improved quality of delivery room care for very preterm infants after introduction of evidence-based delivery room guidelines,” the authors concluded. “Multidisciplinary involvement and continuous education and reinforcement of the guidelines permitted sustained change.”

Study abstract: http://bit.ly/1dw1YxQ


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