759 - Building a Tiny Baby Program: The First Two Years of a Tiny Baby Initiative at a Level III NICU

Publication Number: 2740.759

Helen Healy, Beth Israel Deaconess Medical Center, Brookline, MA, United States; Rachel J. Copertino, Beth Israel Deaconess Medical Center, Boston, MA, United States; Eric Rodriguez, Beth Israel Deaconess Medical Center, Salem, MA, United States; Brianna Connolly, Beth Israel Deaconess Medical Center, Boston, MA, United States; Bryan Meghan, Beth Israel Deaconess Medical Center, Boston, MA, United States; Celine Gaujac, Beth Israel Deaconess Medical Center, Framingham, MA, United States; Nilam K.. Patel, Beth Israel Deaconess Medical Center Boston, Boston, MA, United States; Adrienne Stulck, Beth Israel Deaconess Medical Center, Reading, MA, United States; Kristin Santoro, Harvard Medical School, Boston, MA, United States; Cara J. Budway, Beth Israel Deaconess Medical Center, Canton, MA, United States; Erika R. Sevieri, 659e3ab3879fc950038cc915dabb35fc, Hanson, MA, United States; Gina Story, BIDMC, Melrose, MA, United States; Dewayne M. Pursley, Beth Israel Deaconess Medical Center, Boston, MA, United States; Emily Whitesel, Beth Israel Deaconess Medical Center, Boston, MA, United States

Background: Building a Tiny Baby Program (TBP) requires acknowledging limited evidence and deciding which potentially better practices (PBPs) to adopt or adapt to local context. The Tiny Baby Collaborative (TBC) offers one source of guidance, and the Multicenter Inventory of Neonatal-Perinatal Interventions (MINI) study serves as a source of data collection and benchmarking.

Objective: To describe the development of a structured TBP, focused on infants born < 25 weeks' gestational age (GA), at a level III neonatal intensive care unit (NICU) and present early changes, areas of focus, and measures used to monitor impact.

Design/Methods: The initiative was started in 2023 by a team with members from neonatology, maternal fetal medicine, nursing, respiratory therapy, nutrition, pharmacy, and developmental care, as well as family partners. Consensus building included conducting case reviews and hosting expert lecturers on ethics, epidemiology, and outcomes research. The NICU joined MINI and used the structure of the TBC to organize and prioritize goals. After 18 months, 11 team members visited the University of Iowa, to explore opportunities to adapt elements of their practices to existing practice. The group then finalized a priority matrix and created measures focused on high-priority areas.

Results: Interventions consisted of two ongoing focus areas: skin care, and developmental care; and three core practice changes made over a six-month implementation phase: introduction of high frequency jet ventilation (HFJV), availability of more hypotonic intravenous fluids, and expanding capacity to perform point-of-care (POC) tests. Post-implementation, HFJV is used, 2.5% dextrose and 4mEq/100ml sodium acetate or chloride are available, and electrolytes and hemoglobin can be measured by POC tests. Over 7 months, HFJV was used to treat six infants born < 25 weeks' GA, with mean GA 23 3/7 (22 2/7 - 24 1/7) weeks and mean birth weight 505 (360 - 700) g, resulting in 70 HFJV days and 81.4% of these patients' total ventilation days. Pre-implementation data shows 43% of infants < 24 weeks' GA required insulin and suggests surviving infants < 750g received a mean of 11 (8-14) red blood cell (RBC) transfusions during the first 30 days of life. Post-implementation data collection is ongoing.

Conclusion(s): A robust TBP was formed and after 18 months of pre-work, implemented three core PBPs over a six-month period. Skin and developmental care initiatives are ongoing, with completion of data collection and analysis as important next steps to guide future program development.

Table 1. Measures Proposed and Collected to Assess Impact of a Tiny Baby Program
Definitions of measures and data collected and planned to measure impact of changes.

Figure 1. Timeline of a Tiny Baby Program
Timeline demonstrating key steps in program development, and associated activities.

Figure 2: Tiny Baby Program Interventions
Depiction of early, high priority focus areas and core practice changes introduced early in the course of a Tiny Baby Program.