63 - Standardizing and Improving Neurodevelopmental Follow Up of Infants with Hypoxic Ischemic Encephalopathy in the NICU

Publication Number: 1056.63

Michael Evers, Louisiana State University School of Medicine in New Orleans, New Orleans, LA, United States; Michelle Knecht, Louisiana State University School of Medicine in New Orleans, Metairie, LA, United States; Christy Mumphrey, Louisiana State University School of Medicine in New Orleans, Metairie, LA, United States; Raegan Gupta, Louisiana State University School of Medicine in New Orleans, Metairie, LA, United States; Julie Gallois, LSUHSC New Orleans, New Orleans, LA, United States

Background: Hypoxic Ischemic Encephalopathy (HIE) is a potentially devastating type of brain injury that affects newborns due to brain oxygen deprivation in the peripartum period. Infants diagnosed with HIE are at increased risk for neurodevelopmental delays. Access to early screening and interventions are linked to improved neurodevelopmental outcomes.

Objective: We aimed to improve referral rates and clinic attendance by 20% over a year period.

Design/Methods: To improve the care and outcomes for patients with HIE at a tertiary-care NICU, a multidisciplinary group including neonatologists, nurse practitioners, nurses, and family partners was formed. 57 infants with HIE were identified over a period of three years from January 2021-March 2025. Referral rates and appointment attendances were tracked, including outpatient therapies, early intervention services, audiology, ophthalmology, and NICU follow-up clinic. Bi-weekly meetings reviewed progress and provided staff and families opportunities to discuss barriers and interventions. In December of 2023, an electronic medical record smart phrase was created and disseminated to providers and dedicated NICU case managers to clearly communicate outpatient neurodevelopmental needs for infants with HIE. Smart phrase utilization rates were tracked. Statistical analysis was completed using Chi-square test of independence.

Results: Applying the above interventions, electronic smart phrase utilization rates improved from 0% to 70% (p < 0.01), resulting in improvement in outpatient referrals and clinic attendance exceeding our initial goal of 20%. Outpatient Therapy and Early Steps referral rates improved from 43% to 95% (p < 0.01) and 51% to 90% (p < 0.01) respectively. The percentage of children receiving outpatient therapy increased from 49% to 80% (p=0.04). Ophthalmology referral rates improved from 3% to 100% (p < 0.01) and clinic attendance improved from 5% to 60% (p < 0.01). NICU follow-up clinic referral rates improved from 81% to 100% (p=0.04) and clinic attendance improved from 57% to 70% (p=0.56). Audiology referral rates were maintained from 92% to 95% (p=0.21) and there was an increase in audiology clinic attendance from 62% to 75% (p=0.55).

Conclusion(s): This QI initiative improved the rates of both referrals and clinic attendance, which are critical interventions to improve the neurodevelopmental outcomes and health equity of infants with HIE. This project also underscored the importance of care coordination for infants with complex diagnoses and the value of dedicated NICU case managers.

Smart Phrase Utilization
This figure displays smart phrase utilizations before and after intervention.

Neurodevelopmental Referrals
This figure displays neurodevelopmental referrals before and after intervention.

Neurodevelopmental Clinic Attendance
This figure displays neurodevelopmental clinic attendance before and after intervention.