For the last decade, prematurity has been the leading cause of infant mortality in the United States. As a result of prematurity many infants enter this world too early with a small chance of survival. In order to help treat these extremely premature infants, physicians at Nationwide Children’s Hospital developed a set of guidelines tailored to meet the needs of these tiny infants, some born up to four months early. Now, a new study shows that these guidelines are not only improving survival rates for extremely premature infants, but also improving their quality of life.
This study, appearing in the Journal of Neonatal-Perinatal Medicine, included more than 200 ‘small babies’ – infants born less than 27 weeks gestation – who stayed in the Small Baby Pod inside the Neonatal Intensive Care Unit (NICU) at Nationwide Children’s. These small babies received care following the Small Baby Guidelines and were monitored from birth to at least 2 years corrected age.
Results from this study showed that by following these guidelines, the survival rate of these small babies increased over time. “Our approach was to standardize the level of care, ensuring that every baby received the same care,” said Edward Shepherd, MD chief of the Section of Neonatology at Nationwide Children’s Hospital and co-author of the study. “The idea being that if we do everything the same, for each of these infants, that our results should be better.”
Before these guidelines were instituted, there were very few survivors of babies born less than 27 weeks gestation. In fact, many families and professionals viewed these small babies as having a predestined conclusion of not making it through the first few days of life. However, the findings from this study show that patients who receive care following these Small Baby Guidelines, do very well compared to normal children of the same age.
“The challenge is to convince families and our peers that these are children who, while they have had many challenges, can ultimately lead a normal life,” said Dr. Shepherd, also an assistant professor of Clinical Pediatrics at The Ohio State University College of Medicine. “If you treat patients as if they do not have a chance for survival, these patients don’t do as well as they could. Our approach was that each and every one of these infants has enormous potential for a normal outcome and for a satisfying life.”
In addition to improving survival rates, this study showed that treating babies with this unique approach leads to shorter hospital stays. While small babies often go on to develop infections, necrotizing enterocolitis (NEC) and/or bronchopulmonary dysplasia (BPD), by following these guidelines, babies are recovering from these diagnoses and improving their developmental outcomes leading to an earlier discharge. “This is a real win-win; a shorter stay means parents get to take their child home sooner and it saves an enormous amount of resources,” said Dr. Shepherd.
Part of the success of the Small Baby Guidelines is due to the multidisciplinary approach to treating these infants. The specialized care team includes everyone from physicians and nurses to cardiologists and nutritionists. The goal of this multidisciplinary approach is that every member of the team should understand the goals, the expectations and the gold standard of care so this can be achieved in each patient.
While there is still a need for new approaches to prevent the many illnesses premature infants face when entering the world too soon, physicians and researchers at Nationwide Children’s continue to study ways to prevent illnesses seen in premature infants and the cause of prematurity.
One of the challenges that Dr. Shepherd’s team is facing is changing the way people view the chance of survival for small babies. Their approach is to make people understand that each and every infant has enormous potential for a normal outcome and satisfying life.
Nicholas Metz was born at 24 weeks gestation; just 1 lb., 11 ounces and 11 inches long. As a small baby, he benefited from the guidelines and is now an energetic 20-month-old.