O3302: Improve morbidity and mortality of outborn VLBW infants transported.

Purpose/Objectives: Outborn premature infants are at high risk for adverse outcomes due to a variety of reasons, including access to adequate maternal care, delivery related to emergent conditions, inadequate betamethasone and magnesium administration prior to delivery, delivery at less experienced nurseries and the transport environment. Since 2019, there has been a significant increase in the number of requests for transport to the Level IV NICU of periviable infants, which are at the highest risk for adverse outcomes. Additionally, outborn very low birth weight (VLBW) infants admitted have a higher rate of death/morbidity, chronic lung disease, severe intraventricular hemorrhage (IVH) and hypothermia compared to inborn babies. Interventions are needed to reduce complications associated with prematurity for outborn babies. The Neonatal and Pediatric Transport Program has focused on neuroprotection for the extremely low birth weight population to reduce severe intraventricular hemorrhage as the first stage of reducing mortality and morbidly. Our SMART aim is to reduce severe IVH in outborn VLBW neonates to < 16.5% by March 2024.

Design/Methods: For this quality improvement project, our team has used the key driver diagram and control run chart to track interventions and outcomes. Interventions to improve thermoregulation started with standardizing care in the delivery room at outside hospitals. Our transport team have implemented the STAY WARM guidelines to help transport team members remember the crucial step to maintaining thermoregulation with reminders posted on each transport isolette. To reduce the potential harms of riding in a transport truck, we have started using the Transportle device to maintain a midline position, decrease vibration therefore reducing stimulation, reduction of light and sound exposure. Our next goal is to implement interventions to avoid fluctuations in blood pressure and standardize hypotension management in this population.

Results: Following the initiation of interventions explained above, the rate of severe IVH in outborn VLBW neonates have decrease from 23% in April 2023 to 12% in February 2024. We anticipate a further decrease in severe IVH rates as we initiate the interventions to avoid fluctuations in blood pressure and standardize blood pressure management.

Conclusion/Discussion: The Neonatal and Pediatric Transport Program has been successful at reducing rates of severe IVH in transported VLBW infants by focusing on improving thermoregulation, recognizing special considerations for transport and rethinking blood pressure management.