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Quality improvement project designed to reduce disproportionate growth in extremely low gestational age neonates: cognitive neurodevelopmental outcome at 18–41 months

Journal of Perinatology volume 41, pages 1050–1058 (2021)Cite this article

Subjects

Abstract

Objective

To assess if the adjusted odds of low composite cognitive Bayley-III scores changed after implementing a single-institution quality improvement (QI) project designed to decrease discharge Z-scores for weight, body mass index (BMI), and weight-for-length, but not length or fronto-occipital circumference (FOC) in infants 23–28 weeks gestational age (GA).

Methods

Compare Bayley-III outcomes at ≥18 months corrected age (postnatal age adjusted for prematurity) in infants tested before (Epoch-1) and after (Epoch-2) QI implementation.

Results

Bayley testing was available in 134/156 infants (86%) in Epoch-1 and 139/175 (79%) in Epoch-2. There was no change in frequency of low (<85) cognitive score (p = 0.5) or in median cognitive scores (80 in Epoch-1 vs. 85 Epoch-2, p = 0.35). The adjusted odds of low cognitive scores was not different between Epochs.

Conclusion

No change in cognitive outcome at ≥18 months corrected age was observed after implementing a QI project designed to reduce discharge weight-for-length disproportion in very preterm infants.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

Preliminary data were published, presented or both as follows: Reis J, Tolentino-Plata K, Heyne R, Rosenfeld CR, Brion LP. Does Reducing Weight-For-Length Disproportion at Discharge in Preterm Neonates Affect Neurodevelopmental Outcomes? Presentation at 41st Western Conference on Perinatal Research, Renaissance Esmeralda Resort, Indian Wells, California, January 9, 2020. Reis J, Tolentino-Plata K, Heyne R, Rosenfeld CR, Caraig M, Brion LP. Does Reducing Weight-For-Length Disproportion at Discharge in Preterm Neonates Affect Neurodevelopmental Outcomes? Accepted for poster presentation at PAS, Philadelphia, PA, 5/2/2020; canceled for COVID-19/SARS-Cov-2; presented online at Virtual Regional Neonatal Research Conference 5/26/2020. Reis J, Tolentino-Plata K, Heyne R, Brown LS, Rosenfeld CR, Caraig M, Burchfield PJ, Brion LP. A Quality Improvement (QI) Project Designed to Reduce Weight-For-Length (WtFL) Disproportion at Hospital Discharge in Extremely Low Gestational Age Neonates (ELGANs) Did Not Affect Cognitive Neurodevelopmental Outcomes. Submitted to Annual PAS Meeting 2021.

Funding

George L. MacGregor Professorship (CRR) and Children’s Medical Center Clinical Advisory Committee (CCRAC)—Senior Investigator Research Award—New Direction (LPB).

Author information

Authors and Affiliations

  1. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Jordan D. Reis, Kristine Tolentino-Plata, Roy Heyne, Charles R. Rosenfeld, Maria Caraig, Patti J. Burchfield & Luc P. Brion

  2. Parkland Health and Hospital System, Dallas, TX, USA

    L. Steven Brown

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  1. Jordan D. Reis
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  2. Kristine Tolentino-Plata
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  6. Maria Caraig
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  7. Patti J. Burchfield
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  8. Luc P. Brion
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Contributions

JDR, RH, CRR, and LPB conceptualized and designed the study. JDR wrote the first draft of the manuscript. KTP conducted the Bayley score assessments. MC was the research coordinator for the QI project. PJB collected and entered data into the NICU database. LSB conducted statistical analyses. All authors participated in the interpretation of the data, critically reviewed the revisions, and approved the final manuscript as submitted.

Corresponding author

Correspondence to Luc P. Brion.

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Conflict of interest

The authors declare no competing interests.

Ethical approval

The original QI project, including follow-up, received approval by the Institutional Review Board (IRB) of the University of Texas Southwestern Medical Center, Parkland Health and Hospital Systems and Children’s Medical Center. Informed consent was obtained for all infants in the study who had follow-up at the Thrive clinic.

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Reis, J.D., Tolentino-Plata, K., Heyne, R. et al. Quality improvement project designed to reduce disproportionate growth in extremely low gestational age neonates: cognitive neurodevelopmental outcome at 18–41 months. J Perinatol 41, 1050–1058 (2021). https://doi.org/10.1038/s41372-021-01047-0

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