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Review
. 2022 Feb;42(2):157-164.
doi: 10.1038/s41372-021-00984-0. Epub 2021 Mar 12.

Development of a small baby unit to improve outcomes for the extremely premature infant

Omid Fathi  1 , Leif D Nelin  1   2 , Edward G Shepherd  1 , Kristina M Reber  3
Affiliations
Review

Development of a small baby unit to improve outcomes for the extremely premature infant

Omid Fathi et al. J Perinatol. 2022 Feb.

Abstract

Survival and outcomes for extremely premature (EP) infants have improved and even infants born at 23 and 24 weeks that were previously considered non-viable are now routinely surviving. This review describes our particular institution's basis for and process of creating and sustaining a small baby program for a quaternary, referral-based neonatal intensive care unit. Through multi-disciplinary collaboration, small baby guidelines were developed that established uniform care and optimized evidence-based practice for the care of this unique patient population. A focus on parent-centered care while removing noxious stimuli for the patient has improved neurodevelopmental outcomes. Data collection, quality improvement, and ongoing research are incorporated in the small baby program to establish and sustain best practices and outcomes for the EP patient. Through the establishment of a small baby unit, we have improved survival, decreased short-term morbidities, and improved neurodevelopmental outcomes for the EP infant in our region.

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Conflict of interest statement

OF, LDN, and EGS have no conflicts of interest to declare. KMR is a Board Member of the Children’s Hospital Neonatal Consortium and receives financial compensation in this role.

Figures

Fig. 1
Fig. 1. Mortality of ELBW infants transferred to NCH from 2004 to 2017 decreased from 30% to ~10%.
No reference cited as this is our own original figure.
Fig. 2
Fig. 2. Early successes of the Small Baby Program after implementing standardized guidelines.
A Total fluid intake during the first 72 h of life was lower in the small baby group versus historical comparisons, p < 0.05. Nankervis et al. [8]. Obtained by permission of Acta Paediatr. B Intraventricular hemorrhage in infants in small baby program versus comparison group, p < 0.02. Severe IVH in survivors defined as grade III/IV in those who survived to discharge. Nankervis et al. [8]. Obtained by permission of Acta Paediatr. C Age of survivors at discharge significantly less in small baby program infants versus comparison group, p < 0.05. Nankervis et al. [8]. Obtained by permission of Acta Paediatr.
Fig. 3
Fig. 3. Prophylactic indomethacin associated with reduced mortality in Small Baby Program patients during different time epochs.
Use of PI not significantly different between epochs, and gestational age did not change over time *p < 0.05, **p < 0.005. Nelin et al. [17]. Permission pending.
Fig. 4
Fig. 4. Small Baby Publications and Research Efforts.
A brief list of publications generated from within our Small Baby Program and Small Baby Database.
See this image and copyright information in PMC

References

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