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Development of a small baby unit to improve outcomes for the extremely premature infant

Journal of Perinatology volume 42, pages 157–164 (2022)Cite this article

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Abstract

Survival and outcomes for extremely premature (EP) infants have improved and even infants born at 23 and 24 weeks that were previously considered non-viable are now routinely surviving. This review describes our particular institution’s basis for and process of creating and sustaining a small baby program for a quaternary, referral-based neonatal intensive care unit. Through multi-disciplinary collaboration, small baby guidelines were developed that established uniform care and optimized evidence-based practice for the care of this unique patient population. A focus on parent-centered care while removing noxious stimuli for the patient has improved neurodevelopmental outcomes. Data collection, quality improvement, and ongoing research are incorporated in the small baby program to establish and sustain best practices and outcomes for the EP patient. Through the establishment of a small baby unit, we have improved survival, decreased short-term morbidities, and improved neurodevelopmental outcomes for the EP infant in our region.

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Fig. 1: Mortality of ELBW infants transferred to NCH from 2004 to 2017 decreased from 30% to ~10%.
Fig. 2: Early successes of the Small Baby Program after implementing standardized guidelines.
Fig. 3: Prophylactic indomethacin associated with reduced mortality in Small Baby Program patients during different time epochs.
Fig. 4: Small Baby Publications and Research Efforts.

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Acknowledgements

The authors would like to thank all of the providers from the various disciplines that have coalesced around a unifying goal of improving outcomes in our most vulnerable patients. From its inception to today, the growth and success of the Small Baby Program at Nationwide Children’s Hospital would not be possible without such a selfless and collaborative effort. Furthermore, we want to recognize and thank all our patients and their families, from whom we learn every day.

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Authors and Affiliations

  1. Small Baby Unit, Division of Neonatology at Nationwide Children’s Hospital and Department of Pediatrics at The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Omid Fathi, Leif D. Nelin, Edward G. Shepherd & Kristina M. Reber

  2. Center for Perinatal Research, The Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA

    Leif D. Nelin

Authors
  1. Omid Fathi
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  2. Leif D. Nelin
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  3. Edward G. Shepherd
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  4. Kristina M. Reber
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Correspondence to Kristina M. Reber.

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OF, LDN, and EGS have no conflicts of interest to declare. KMR is a Board Member of the Children’s Hospital Neonatal Consortium and receives financial compensation in this role.

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Fathi, O., Nelin, L.D., Shepherd, E.G. et al. Development of a small baby unit to improve outcomes for the extremely premature infant. J Perinatol 42, 157–164 (2022). https://doi.org/10.1038/s41372-021-00984-0

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