Resident Physician Akron Children's Hospital Akron, Ohio, United States
Background: Morbidity rates of surviving preterm infants is highest among the lowest gestational age [1].Extremely premature infants are a special sub-population at high risk of morbidities and raise a challenge to optimizing care and outcomes. Prior studies have shown that a unit dedicated to extremely preterm babies can improve outcomes [2, 3].The goal is to provide standardized, comprehensive care that focuses on improving morbidity and mortality for extremely premature infants. Objective: The purpose of this study is to compare neonatal outcomes in infants born at < 30 weeks gestation before and after initiation of a small baby unit (SBU) at a single institution. The primary outcomes studied are retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), chronic lung disease (CLD), severe intraventricular hemorrhage (IVH), nosocomial infection, and mortality. Design/Methods: This retrospective cohort analyzes de-identified data contained in the Vermont Oxford Network (VON) database for a single institution. Data includes out-born infants of gestational age 29 weeks 6/7 days or less admitted to Akron Children’s Hospital (ACH) level IV NICU within the first 3 days of life, from 2015-2021. All infants were born to mothers who received prenatal care. The study included a total 542 patients. We compared two cohorts, defined as prior to SBU (n=251) and after initiation of SBU (n=291). The primary variables include severe ROP, NEC (surgical and/or medical management), CLD (infants requiring supplemental oxygen at 36 weeks and beyond), severe IVH (stage III or higher), nosocomial infection, and mortality.Variables were compared amongst the two cohorts using chi-square test p-values, with statistical significance defined as p< 0.05. Results: There was significant improvement in the incidence of severe ROP after initiation of the SBU, 28.8% before compared to 20.4% after, with p=0.0364. The following outcomes did not show a significant difference after initiating SBU: CLD (p=0.875), NEC (p=0.747), nosocomial infection (p=0.425), severe IVH (p=0.866), and mortality (p=0.414). There was increased incidence of CLD and NEC after starting the SBU, although not statistically significant.
Conclusion(s): Overall, the initiation of a SBU did not significantly improve neonatal outcomes, except for severe ROP. Our study was the first to analyze these outcomes at ACH since initiating the SBU. Further research is needed to suggest improvements in the SBU protocol and to assess the best tools for improving outcomes of extremely premature infants. The study limitations include sample size and single institution data.
