760 - Improved Survival and Neurodevelopmental Outcomes of 22–24 Week Infants Following Implementation and Maturation of a Tiny Baby Collaborative at Orlando Health Winnie Palmer Hospital

Publication Number: 2741.760

Thais O. Queliz, Arnold Palmer Hospital for Children, Winter Park, FL, United States; Michael JOSEPH. McMahan, Arnold Palmer Hospital for Children, Windermere, FL, United States; Samantha Enstad, Arnold Palmer Hospital for Children, Orlando, FL, United States; Kathryn A. Winn, Arnold Palmer Hospital for Children, Windermere, FL, United States; Karla Diaz Ayllon, Pediatrix, Windermere, FL, United States; Catherine Love, Arnold Palmer Hospital for Children, Orlando, FL, United States; Amy Kelly-Vega, Orlando Health Winnie Palmer Hospital, Orlando, FL, United States; Sindhuri Avula, Orlando Health, Orlando, FL, United States; Carol Fischer, Arnold Palmer Hospital for Children, orlando, FL, United States; Allison Ramey, Orlando Health, Orlando, FL, United States

Background: Survival of infants born at 22-24 weeks' gestation remains highly variable among centers. In 2017, our institution launched the Tiny Baby Collaborative (TBC) to standardize care for periviable infants, though early implementation was hindered by limited stakeholder engagement and inconsistent adherence. In 2020, the TBC was restructured with stronger hospital partnership, multidisciplinary leadership, and strict adherence to evidence-based protocols.

Objective: To evaluate changes in survival and early neurodevelopmental outcomes of 22-24 week infants following implementation and maturation of the Tiny Baby Collaborative.

Design/Methods: A retrospective cohort study included all inborn NICU admissions at 22-24 weeks' gestation at a single Level IV center. Cohorts were defined as 2014-2016 (Pre-TBC), 2017-2019 (Early TBC), and 2020-2024 (Mature TBC). The primary outcome was survival to discharge. Secondary outcomes included rates of severe intraventricular hemorrhage (IVH) and neurodevelopmental impairment (NDI) at 17-22 months' corrected age (Bayley III and cerebral palsy classification). Chi-square (χ²) tests were used for group comparisons, and relative risk (RR) with 95% confidence intervals (CI) were calculated.

Results: 22-24 weeks: Survival improved from 55.4% (77/139) and 50.7% (74/146) to 71.3% (179/251) (p < 0.001; RR 1.41 [1.19-1.66]).
22-23 weeks: Survival increased from 35.7% (30/84) to 66.4% (91/137)-a 30.7-point absolute increase and 86% relative improvement (p < 0.001; RR 1.86 [1.33-2.60]).
Severe IVH (22-24 weeks) decreased from 37.6% (47/125) to 23.8% (57/240) (χ² p=0.008; RR 0.63, 95% CI 0.46-0.87).
Among 179 discharges (2020-2024), 41 completed developmental follow-up at 17-22 months: 24 (59%) had no/mild NDI, 13 (32%) moderate, and 4 (10%) severe. For 22-23 week infants (n=22), 13 (59%) had no/mild and 4 (18%) severe NDI, indicating favorable early outcomes.

Conclusion(s): Following full implementation of the Tiny Baby Collaborative-with standardized protocols, coordinated perinatal care, and institutional alignment-survival of 22-24 week infants improved from ~50% to >70%, and survival of 22-23 week infants from 36% to 66% (RR 1.86, p < 0.001). Rates of severe IVH decreased significantly from 37.6% to 23.8% (p = 0.008), reflecting enhanced neuroprotective practices and multidisciplinary consistency. Preliminary neurodevelopmental data show most survivors have no or mild impairment, demonstrating improved survival without compromising neurologic outcomes.

Sustained Improvement in Survival Among 22-24 Week Infants Following Implementation of Standardized Periviable Protocols
Control chart showing survival of 22-24 week infants (2014-2024). Survival improved from 53% to 71% after protocol implementation in 2020 (RR 1.35, 95% CI 1.17-1.54, p<0.001). For 22-23 weeks, survival rose from 36% to 66% (RR 2.16, 95% CI 1.56-2.99, p<0.001). In 2024, survival reached 80%, including all infants <400 g.

Neurodevelopmental Outcomes of 22-24 Week Infants (2020-2024 Cohort)
Among 41 infants with completed follow-up at 17-22 months, most demonstrated favorable outcomes: 59% had no/mild impairment, 32% moderate, and 10% severe. For 22-23 week infants, 59% had no/mild and 18% severe NDI, indicating reassuring early developmental trajectories.

Improved Survival Across All Gestational Ages Since 2020
Survival trends for 22-24 week infants (2014-2024). Overall survival improved from 51% (2017-19) to 71% (2020-24) following standardized periviable protocols. Survival by gestational age in 2020-24: 22 wk 56%, 23 wk 72%, 24 wk 77%. Sustained gains reflect consistent implementation of multidisciplinary Tiny Baby care practices.