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Small Baby Guidelines Help Preemies Thrive
More premature babies at Nationwide Children’s Hospital are thriving thanks in large part to guidelines developed and tested at the bedside.
The Small Baby Guidelines (SBGs), developed by the neonatology team at Nationwide Children’s, provide a uniform, interdisciplinary approach to the family-centered care of extremely premature babies. The guidelines outline care regarding development, nutrition, cardiovascular functioning, infection and other potential health concerns during the first week of these infants’ lives.
A few years ago, the survival rate for babies born at 23 weeks was 10 percent. Today, the survival rate at Nationwide Children’s is 63 percent thanks in large part to the standardized care that the guidelines provide.
Recent Research
Testing the Effectiveness of the Guidelines
The first set of SBGs were implemented seven months after a Small Baby Committee was formed and were used in the care of all infants born fewer than 27 weeks gestation and who were fewer than 7 days old. To determine the effectiveness of the guidelines, the neonatology team gathered data on all 41 infants cared for during the guideline’s first year and compared these to data on 40 same-age infants who were admitted during the year leading up to the SBG implementation.
Results showed that babies treated according to the SBGs had a substantially shorter hospital stay than those cared for the year prior to the implementation. Fewer SBG babies experienced intraventricular hemorrhage (IVH) and fewer of the babies with BPD, a common health issue associated with premature birth, needed to be sent home with oxygen.
Additional Guidelines and a Small Baby Pod
Since this study, the Small Baby Committee has developed two additional sets of guidelines, one detailing care for infants age 8 days to age 28 days and the other for infants age 29 days through discharge. To facilitate the standardized care of these patients, there is now a 10-bed small baby pod dedicated within the neonatal intensive care unit (NICU), which provides a quiet environment with controlled lighting.
NICU Develops Small Baby Guidelines
The Neonatal Intensive Care Unit (NICU) began developing the Small Baby Guidelines (SBG) when it was discovered that patients were being cared for by three distinctly different neonatology practices. Preliminary findings of the SBG initiative found that preterm infants, when provided amino acids immediately after birth, showed significantly improved weight at discharge compared to preterm infants receiving amino acids later in their care. One of the most common complications in premature infants is slow growth after delivery that has been attributed to lack of early nutrition support. Amino acids are the building blocks for protein, which is essential for growth.
Amy was a case study; born at 26 weeks gestation, weighing 793 grams. She was treated with intermittent positive pressure ventilation for a total of 64 days. As per the Small Baby Guidelines, she was started on early breast milk feeds on day of life three and was on full feeds by day of life 18. Amy also had several head ultrasounds. None of the ultrasounds demonstrated any intracranial pathology. She was discharged home from the NICU when she was 99 days old, at 40 weeks corrected gestational age. Amy is now a thriving, typically developing 4-year-old.
Nationwide Children's Hospital
700 Children's Drive Columbus, Ohio 43205 614.722.2000
700 Children's Drive Columbus, Ohio 43205 614.722.2000