Sustained Evidence-Based Better Care Practice Implementation and Outcomes Among Very Preterm Infants: A Quality-Improvement Study in a Level 4 Neonatal Intensive Care Unit in Southern China

Excerpt

To the Editor: Quality improvement (QI) program has improved very preterm infants (VPIs) outcomes [1, 2]. However, programs on sustained evidence-based better care practice (EBCP) among VPIs has rarely been reported in the developing countries. This study aimed to determine whether sustained EBCP in developing countries such as China could improve outcomes in VPIs. Since 2018, a series of the best evidence-based better practice dedicated to improving the VPIs outcomes was implemented in a level 4 NICU in southern China. These strategies included using umbilical cord blood for the initial blood tests, delayed cord clamping, positive end-expiratory pressure respiratory support right after birth, new guideline to reduce antibiotic use, double wall incubators for intrahospital transport, minimally invasive surfactant treatment and revised parenteral nutrition prescription. A total of 839 VPIs were tracked from 2017 through 2022. After the sustained EBCP, survival without major morbidity increased from 87.9 to 92.4% (p = 0.024). The incidence of three common morbidities significantly reduced- discharge weight <10th percentile (83.8 to 69.1%), severe bronchopulmonary dysplasia (sBPD) (5.0 to 1.8%) and late-onset sepsis (14.9 to 5.7%) (p <0.05). Among all the better practices, strategies to reduce intubation could decrease 17.37 times the risk for sBPD, which brought the most prominent benefit in reducing sBPD (59% contribution). Our study also provided detailed compliance with EBCP and resource utilization. This sustained EBCP implementation program in a level 4 NICU in southern China led to a significant increase in survival without major morbidity among VPIs, decreased several morbidities, and promoted the provision of improved care practices. Sustained EBCP implementation is an effective and feasible way to improve the quality of care [3, 4]. It also applies to developing countries that focus on improving patient outcomes by using our existing knowledge and resources. …