761 - EARLY DAYS GENTLE WAYS – Standardising care and improving outcomes in mirco-preemies (22+0 to 24+6 weeks)

Publication Number: 2742.761

Thae Nu Wai, Health Education England, Ashford, Kent, England, United Kingdom; Anna Athanasia Ntovolou, East Kent University Hospitals, Ashford, England, United Kingdom; Shavindra Chellen, East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital, Ashford, England, United Kingdom; Madhusudan Guin, NHS England, Ashford, England, United Kingdom; Shaveta Mulla, East Kent University Hospital UK, Ashford, England, United Kingdom

Background: Prematurity remains the leading global cause of death in children under five. Infants born at the edge of viability face high mortality, morbidity, and variation in care. British Association of Perinatal Medicine (BAPM) 2019 framework, advocated proactive, survival-focused care which led to an increase in local birth rates at this gestation. This highlighted the need for a standardised, system-wide quality improvement approach aligned with international evidence.

Objective: To implement and evaluate the "Early Days, Gentle Ways" (EDGW) initiative for babies less than 25 weeks to standardise early care and improve adherence to best practice, clinical outcomes, encouraging staff empowerment, and family experience.

Design/Methods: EDGW was registered as a service evaluation under the Trust's QI framework; formal REC approval was not required (NHS HRA, 2023). A visual 10-step pathway guided care across antenatal, delivery, and postnatal domains. Multidisciplinary clusters covered antenatal counselling, stabilisation, thermoregulation and delivery room cuddles, first hour of care, nutrition, and neuroprotection. Each team was led by a consultant with a nurse and trainee, advocating distributed leadership and psychological safety.

Core interventions included: standardised antenatal counselling pack; senior-led delivery room stabilisation with thermal chain maintenance and gestation-specific surfactant dosing; delivery room cuddles and colostrum within six hours; super 60 golden-hour optimisation; slow-feeding protocol; and environmental neuroprotection ("STOP to Rest"). Two preterm families provided structured feedback on all domains, which was incorporated into the pathway design to strengthen parental partnership.

Results: Improved and standardised protocols were integrated into Trust governance with live dashboards, and a slow feeding regimen was initiated. Ongoing audit data show measurable improvements in thermoregulation, delayed cord clamping, and early colostrum mouth care within 48 hours post-birth. All babies meeting the safety criteria received delivery room cuddles. Ninety percent of staff reported feeling empowered, with an increased sense of collaboration and teamwork.

Conclusion(s): EDGW is a replicable Micro-Preemie care model with measurable outcomes, embedding international standards into UK practice. Standardised interventions improved care, staff empowerment, and family experience. Next steps include sustainability of the project, scaling to wider networks and developing a comprehensive antenatal-to-follow-up ecosystem.

VISUAL OVERVIEW OF CORE INTERVENTIONS ALONG THE EDGW CARE PATHWAY
Overview of the EDGW care pathway illustrating the continuum of standardised care from birth to neonatal intensive care. The framework integrates key domains - antenatal optimisation, delivery room stabilisation, Super 60 bundle, neuroprotection, respiratory management, nutrition, and continuous audit and monitoring - promoting consistency, safety, and family-centred practice for infants born at 22+0-24+6 weeks.

Key Intervention Components and Implementation Tools
This image illustrating the core components of the EDGW initiative for Micro-Preemies (22+0-24+6 weeks). The figure highlights intervention areas across antenatal counselling, delivery-room stabilisation, delivery-room cuddles and colostrum, Super 60 golden-hour protocol, nutrition, and neuroprotection. Each component is supported by practical tools such as checklists, cue cards, posters, and parent information resources used to embed standardised, family-centred care in daily practice.

EDGW Intervention Clusters and Multidisciplinary Team Configuration
This diagram illustrates the thematic teams formed under EDGW and their aligned intervention domains across the perinatal-neonatal care continuum.