Researchers Find "Micro Preemie" Infant Outcomes Improve Over Long-term Due to Quality Improvement Collaborative

Extensive retrospective study shows increased survival, reduced infections and potentially better respiratory practices among very low birth weight infants at hospitals in the collaborative

MINNEAPOLIS/ST. PAUL, March 1, 2010 —New research published in the March issue of Pediatrics shows that long-term quality improvement efforts are associated with sustained improvement in outcome and survival for very low birth weight infants, or "micro preemies," treated in neonatal intensive care units (NICU) in a quality improvement collaborative (QIC). The study defined low birth weight infants as those who weigh between 501 and 1,500 grams (less than 3 pounds, 5 ounces).

The retrospective study of more than 4,000 very low birth weight infants showed that participation in the QIC was associated with sustained implementation of potentially better respiratory practices, increased survival and reduced hospital-acquired infections. Researchers analyzed nine years of data related to practices and outcomes from the eight NICUs that form the Reduced Lung Injury group of a QIC sponsored by the Vermont Oxford Network.

"This study shows that QICs really can improve outcomes, even though it may take not weeks or months but years," said the study's lead author, Nathaniel R. Payne M.D., a neonatologist at Children's Hospitals and Clinics of Minnesota, one of the eight hospitals in the QIC.

"In addition, we saw enduring changes in the treatment practices, another key goal of QICs," added Payne.

Research into better treatment practices for micro preemies is important due to the fact that, although significant strides have been made in the treatment of these low birth weight babies, these patients continue to face significant obstacles to their survival and quality of life.

Among the significant changes in practices that were developed and adopted early among the collaborative from 1998 to 2006 were reductions in the use of mechanical ventilation (from 75 percent to 62 percent), delivery room intubation (from 70 percent to 52 percent), postnatal steroids (from 35 percent to 10 percent) and increase in the early administration of surfactants (from 55 percent to 81 percent) and nasal continuous positive airway pressure (from 57 percent to 78 percent).

The study found that these potentially better practices were significant and sustained, infection rates were reduced (from 18 percent to 15 percent) and survival rates improved (from 90 percent to 93 percent).

"The bottom line is that quite a few babies survived that might not have otherwise, and the reduction in infection rates meant fewer deaths, shorter hospital stays and lower costs," Dr. Payne said.

The study did not find, however, that these practices lead to a reduction in the rate of a chronic lung disorder among micro preemies called bronchopulmonary dysplasia (BPD), which involves inflammation and scarring in the lungs. BPD, which increased from 25 percent to 29 percent, has been associated with prolonged use of mechanical ventilation.

"Reducing BPD rates may be more complicated than merely reducing mechanical ventilation," said Dr. Payne. "These results will help guide our future quality improvement initiatives to reduce BPD."

Since postnatal steroids are known to impede growth and neurological development, one of the goals of the QIC was to reduce their use. However, these steroids can reduce BPD, so limiting their use may have contributed to the increase in BPD, according to Dr. Payne.

The study's findings support the value of long-term quality improvement efforts to understand the condition of patients and the complex interactions of therapies used to treat them.

"This sort of collaborative – my hospital, Children's of Minnesota participates in a number of them – is essential to accelerate improvement in pediatric care," said Dr. Payne.

About Children's Hospitals and Clinics of Minnesota

Serving as Minnesota's children's hospital since 1924, Children's Hospitals and Clinics of Minnesota is the seventh-largest pediatric health care organization in the United States, with 332 staffed beds at its two hospitals in St. Paul and Minneapolis. An independent, not-for-profit health care system, Children's of Minnesota provides care through more than 14,000 inpatient visits and more than 200,000 emergency room and other outpatient visits every year. Children's is the only Minnesota hospital system to provide comprehensive care exclusively to children.

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