760 - Statewide Quality Collaborative to Optimize Newborn Care Delivery Practices and Outcomes Across Alabama

Publication Number: 1736.760

Kelechi Ikeri, University of South Alabama College of Medicine, Mobile, AL, United States; Caitlin Ballard, Alabama Perinatal Quality Collaborative, Birmingham, AL, United States; Britta Cedergren, University of Alabama at Birmingham, Alabama Perinatal Quality Collaborative, Birmingham, AL, United States; Martha S.. Wingate, University of Alabama at Birmingham, Birmingham, AL, United States; Samuel Gentle, Yale School of Medicine, New Haven, CT, United States

Background: Implementation of best practices such as hypothermia prevention, delayed cord clamping (DCC), and avoidance of endotracheal intubation in the delivery room play a key role in reducing neonatal mortality and morbidity.

Objective: Initiative aims included: (1) to reduce newborn hypothermia ( < 36.5C) on admission by 20% across birthing centers, (2) to increase DCC by 20% and (3) to reduce delivery room intubations by 20% among infants < 30weeks GA in Level III/IV centers by July 2025 (over an 18-month period).

Design/Methods: In December 2023, a quality improvement (QI) initiative was launched across 24 hospitals. Fourteen Level I/II units participated in a newborn hypothermia prevention initiative, while ten level III/IV units engaged in a broader "Golden Hour initiative" targeting hypothermia prevention, improved DCC and reduction of delivery room intubations. Baseline data were collected from December 2023 to February 2024 and interventions began in March 2024. Key drivers included optimizing delivery preparation and support, real time identification of improvement opportunities and provision of resources to staff and families (Figure 1, Panels A & B). Outcome measures were the proportion of infants with: hypothermia on admission, DCC, intubations, continuous positive airway pressure (CPAP) use in the delivery room and intraventricular hemorrhage (IVH). The balancing measure was the percent of infants who were hyperthermic (>37.5C) at delivery. Measures were tracked monthly with the use of p-charts to assess for special cause variation.

Results: A total of 6927 newborns were included in this initiative (6057 from level I/II, and 870 from level III/IV). In level I/II units, the monthly percent of newborns with hypothermia on admission decreased from 18% to 14% (Figure 2), and moderate to severe cases decreased from 1.7% to 1.4%. In level III/IV units, the monthly percent of newborns with hypothermia on admission remained stable at 30%; however, moderate to severe cases decreased from 12% to 6% (Figure 3A). Severe IVH (Figure 3B) decreased from 10% to 6%, while DCC increased from 46% to 60% (Figure 3C). Intubations, CPAP use and IVH were stable at 42%, 63% and 22% respectively. Hyperthermia remained stable at 10% among level I/II units. and 5% among level III/IV units.

Conclusion(s): Through the state's perinatal quality collaborative, improvements in hypothermia, DCC and moderate to severe IVH were achieved across diverse hospitals. Future efforts will focus on sustainment of improvement gains across participating sites.

Figure 1
Key Driver Diagram

Figure 2. p chart. Level I/II units.
Hypothermia on admission.

Figure 3. p-chart. Level III/IV units.
A. Moderate to severe hypothermia on admission. B. Severe Intraventricular Hemorrhage. C. Delayed Cord Clamping