Effects of Continuous Quality Improvement on Complication Rate and Treatment Outcome of Extremely Premature Infants

Abstract

Background: Extremely premature infants (EPIs) are those less than 32 weeks of gestational age. Preterm birth is the leading cause of neonatal death and poor prognosis, accounting for 25% of neonatal deaths, with extremely premature births accounting for 50% of all premature deaths. Continuous quality improvement (CQI) improves patient outcomes by changing and optimizing clinical practice including increasing participation of neonatologists in prenatal consultation, maintenance of normal body temperature in preterm infants, early use of pulmonary surfactant, reduction of mechanical ventilation time and intensive breastfeeding to reduce clinically avoidable adverse events.

Objective: The risk of death and disability is high for very preterm infants, with a mortality rate of 30-50% and a risk of at least 20-50% for survivors. This study aimed to investigate the effect of CQI on the incidence of complications and treatment outcomes in very preterm infants.

Design: This was a retrospective study.

Setting: This study was conducted in the Maternal and Child Health Hospital of Hubei Province.

Participants: A total of 140 EPIs born in our hospital and transferred to the neonatal intensive care unit between August 1, 2020, and July 31, 2022, were enrolled. The EPIs were divided into two groups: before improvement (n=79, 56.4%) and after improvement (n=61, 43.6%) according to the week of birth, and the gestational age ranged from 26 weeks to 26 weeks 6 days into the 26 weeks group.

Interventions: From August 2021, the hospital implemented the CQI method, which included neonatologists' participation in consultations before birth, the care of a professionally trained resuscitation team after birth, and the introduction of transport heating tanks and ventilators during transport.

Primary outcome measures: (1) Apgar score (2) body weight (3) duration of invasive ventilation (4) length of stay (5) treatment expense (6) incidence of complications and (7) survival rate of EPIs.

Results: The application of CQI methods resulted in significant improvements in body weight (1305 g vs 1404 g) and duration of invasive ventilation (4.64 d vs 7.40 d) in EPIs (P = .036 and P = .040), reduced the time of invasive mechanical ventilation decreased significantly, from 7.4 days to 4.64 days (P < .01), increased the median temperature of newborn infants (36.2°C vs 35.7°C) (P = 0), increased the proportion of newborn infants with a temperature greater than 36°C (67.2% vs 35.4%) (P < .001), reduced the incidence of complications in EPIs (32.79% vs 45.57%) (P < .05).

Conclusion: The application of the CQI approach significantly increases the body temperature, improves the incidence of complications of EPIs, and is conducive to the survival of EPIs. Our study may provide a clinical reference for management of EPIs.