Updated Small Baby Care Guidelines Reflect 20 Years of Work Toward Improved Outcomes

Thorough management guidelines for babies born before 27 weeks’ gestation join the program’s long list of accomplishments in improving survival and standardizing care for this vulnerable population.

As the Small Baby Program at Nationwide Children’s Hospital celebrates its 20^th anniversary, it is also releasing its latest set of care guidelines for their tiny patients. Divided according to gestational age, care discipline and postnatal time period, the guidelines provide digestible and thorough guidelines for patient management from delivery up through discharge home.

“Our guidelines cover the whole journey through the neonatal intensive care unit, which is pretty unique,” says Jessica Laubensheimer, MSN, RN, the Small Baby nurse coordinator for the program across all 11 NICUs in the Nationwide Children’s neonatal network. “Each discipline also has their own specific training and requirements for who can work in the Small Baby Program, and we all commit to following those guidelines — and changing with them as they get updated over time — as an essential part of our mission.”

Although the team was originally founded by a multidisciplinary group of neonatologists and support staff, the group has grown to include specially trained pharmacists, nurses and neonatal nurse practitioners, physical and occupational therapists, respiratory therapists, speech therapists, social workers, nutritionists and more.

“The first stepping stone to better outcomes is a standardized approach,” explains Omid Fathi, MD, medical director of the Small Baby Program at Nationwide Children’s. “Things get better as we do them the same way, and it makes it possible for us to evaluate outcomes and begin the improvement cycle again. Even in the early literature we published, we saw dramatic improvements in survival and long term follow-up.”

The team’s iterative approach has resulted in tangible progress across numerous outcomes. Chief accomplishments published to date include a decline in overall mortality from 30% to 10%, a reduction in bronchopulmonary dysplasia from 68% to 50%, reduction in oxygen use from 65% to 42%, significantly reduced length of stay, dramatic increases in kangaroo care, systematic reductions in noxious stimuli such as direct lighting and blood pressure checks, and improvements in neurodevelopmental outcomes as measured by the Bayley Scales at 18-24 months of age.

The team now has their sights set on further improvements in survival rate and long-term outcomes for babies at the earliest limits of viability, having already improved survival rate from 19% to 48% for infants born at 22 weeks’ gestation and from 10% to 78% for those born at 23 weeks.

In addition to continually refining their practice guidelines, the Small Baby team conducts clinical research and follows patients for long-term development and referral needs. They also routinely advise other hospitals on the development of small baby care and quality improvement techniques.

“We have been fortunate that from hospital leadership down to our division leadership, we have always had great support for this effort,” says Dr. Fathi. When Nationwide Children’s new main campus tower is complete, the program will move into a specially designed 24-bed Small Baby Unit to support the 100+ infants and families they care for annually. “Our focus in the coming months and years will be to continue to optimize care for those 22- and 23-weekers, not just to improve survival but to limit the comorbidities these babies face as well, so that one day they can have outcomes just as good as those born at 25 weeks.”

Reference:

Fathi O, Nelin LD, Shepherd EG, Reber KM. Development of a small baby unit to improve outcomes for the extremely premature infant. J Perinatol. 2022 Feb;42(2):157-164.

Image credit: Nationwide Children’s