P2.H152: Improving Outcomes of Premature Infants Born at 22 0/7 to 23 6/7 weeks Gestation: A Multidisciplinary Quality Initiative

Purpose/Objectives: Active treatment and intensive care support continues to vary amongst infants born at 22 0/7 to 23 0/7 weeks gestational age (ULGAN). Literature has shown variation in practice and care, significantly influences infant outcomes. A review of our Vermont Oxford Network outcomes showed 25% survival and 51% survival among inborn 22- and 23- week infants respectively. We aimed to develop a multidisciplinary approach with in collaboration with interprofessional staff to increase survival (Figure 1).

Design/Methods: This was a single-center, prospective, quality improvement initiative including infants born at 22 0/7 to 23 0/7 weeks gestation, admitted to our Pavilion for Women Neonatal Intensive Care Unit from January 1, 2023. Previous practices lacked a standardized approach to counseling and care. Plan Do Study Act (PDSA) cycles included attitude surveys, an ethical framework for resuscitation practices, guidelines, and revisions. Outcome measures included short-term morbidities such as severe intraventricular hemorrhage (IVH), early onset sepsis (EOS), late infection, spontaneous intestinal perforation (SIP)/ necrotizing enterocolitis (NEC), surgical patent ductus arteriosus (sPDA), severe retinopathy of prematurity (ROP), and bronchopulmonary dysplasia (BPD). Process measures included consult completion, antenatal steroid completion, and adherence to major recommendations of the care guidelines. Balancing measures included length of stay.

Results: Twenty-two inborn infants were included. Survival to discharge was 55% (n=6/11) for 22-week infants and 73% (n=8/11) for 23-week infants (Figure 2). After exclusion of precipitous deliveries the antenatal neonatology consult completion rates were 88% and 100% for 22- and 23-week infants respectively. 100% of mothers had antenatal steroid course initiated prior to delivery. 100% of 22-week infants were initiated on high frequency ventilation (HFV) and received prophylactic surfactant following delivery while only 45% of 23-week infants were initiated on HFV and 82% received prophylactic surfactant. Rates of severe IVH were low amongst survivors at 0% for 22-week infants and 13% for 23-week infants. Among survivors born at 22 weeks, there were no cases of EOS, SIP, or NEC. All 22-week survivors had BPD, 67% had late infection, 33% had a sPDA, and 50% had severe ROP. Among 23-week survivors there were no cases of EOS. Amongst 23-week survivors, 50% had SIP/NEC, 87% had BPD, 63% had late infection, 13% had a sPDA, and 25% had severe ROP.

Conclusion/Discussion: A multidisciplinary and uniformed approach to the care of infants born at 22 0/7 to 23 6/7 weeks gestational age resulted in increased survival. Future work will focus on adherence to care guidelines, improving short- and long- term in these infants.