A recent study conducted by the Columbus Childrens Hospital Newborn Intensive Care Unit (NICU) staff at Childrens main campus was designed to determine if the implementation of a standardized set of guidelines for the care of extremely premature infants in their first week of life would improve patient outcomes. Given the complex and unique medical problems that these highly vulnerable patients present to the NICU health care team, a consistent plan of care must be developed. The study was conducted at Columbus Childrens NICU, an all referral unit with patients cared for by three separate groups of neonatologists. Study results will be presented May 1 at the 2006 Pediatric Academic Societies Annual Meeting in San Francisco.
An interdisciplinary group from Columbus Childrens NICU, including NICU nurses who achieved Magnet Status in nursing last year, met to construct a standard set of guidelines for the care infants receive in the first week of life. These guidelines were implemented November 1, 2004 for the care of all patients (in the Columbus Childrens Hospital NICU) 27 weeks gestational age (GA) or less and seven days of age or younger. Age-matched infants admitted to Columbus Childrens NICU between November 1, 2003 and October 31, 2004 were used as a comparison group.
The new standard set of guidelines, center around health problems in extremely premature infants. They include respiratory (high risk of lung disease), delicate skin, development of intracranial hemorrhages (high risk for neurological and developmental abnormalities), cardiovascular (high risk for low blood pressure) and , infection and high risk for neurological and developmental abnormalities.
Utilizing the new guidelines, significant changes in outcomes were found in the study group at Columbus Childrens NICU. Of the 26 patients meeting the criteria to be included in the study, 96% survived the first week of life, and 70% of the patients survived until hospital discharge. In comparison, 40 patients were cared for in the previous group (Nov. 1, 2003 Oct. 31, 2003) where 82.5% of the patients survived the first week of life, and 70% of the patients survived until discharge. The average length of stay for the patients cared for under the new standard protocol had dropped from 145 days to 107 days, reducing the average hospitalization time by more than one month.
At the conclusion of this study, we found that a standard protocol in the care of extremely premature infants in the crucial first week of life resulted in a decrease in the length of hospitalization and an increase in the survival rate of the first week of life, said Elizabeth Martin, RN, Columbus Childrens Hospital NICU and study co-author. Based upon the data, Columbus Childrens Hospital NICU is working on phase II in developing guidelines for the standardization of care for extremely premature infants during the the entire hospital periodsecond through the fourth weeks of life.