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QI Toolkit

Nutritional Support of the VLBW Infant

Managing the nutritional needs of preterm and ill newborns, especially the very low birthweight (VLBW) infant, has never been easy. Although the incidence of postnatal growth failure has improved over the last decade, there remains an unacceptably high rate of growth failure (50%) for VLBW infants. In the past several years there has been considerable basic science and clinical research on the nutritional needs of preterm infants and the optimum ways to provide that nutrition to prevent nutritional and growth deficits and ensure ideal multiorgan and system outcomes.

Severe Hyperbilirubinemia Prevention

Neonatal hyperbilirubinemia is a frequent and generally benign condition for which safe and effective treatments exist. When hyperbilirubinemia goes untested or unmonitored, otherwise healthy newborns are at risk for bilirubin neurotoxicity. The Severe Hyperbilirubinemia Prevention Toolkit reviews guidelines for the identification and follow-up of term and near-term infants (greater than 35 weeks gestation) at risk for hyperbilirubinemia.

 

Neonatal Disaster Preparedness

Neonatal patients have unique needs that distinguish them from most other hospitalized patients. Infants in the NICU are highly dependent on hospital staff for all aspects of their care. Many are critically ill and are heavily dependent on advanced technology for their survival. Any number of disasters has the potential to impact a NICU’s ability to care for their patients.

Neonatal Therapeutic Hypothermia

Therapeutic hypothermia, when initiated within six hours of birth, has been shown to significantly improve survival and neurodevelopmental outcomes in neonates with moderate to serve hypoxic-ischemic encephalopathy (HIE). However, not every baby who might benefit from cooling therapy is identified or referred to a regional cooling center in a timely fashion. Early identification of the risk factors for perinatally-acquired asphyxia and recognition of the signs and symptoms of neonatal encephalopathy are challenging even for the most experienced neonatologists. 

Perinatal HIV

The Perinatal HIV toolkit summarizes the current recommendations of the U.S. Department of Health and Human Services (HHS) Panel on Treatment of HIV-infected Pregnant Women and Prevention of Perinatal Transmission (a working group of the Office of AIDS Research Advisory Council). The toolkit is designed to assist healthcare providers in providing HIV information and prenatal testing and care to pregnant women. 

Care and Management of the Late Preterm Infant

Late preterm infants (LPI) (those born 34 to 36 6/7 weeks gestation) comprise a unique population requiring enhanced awareness and sensitivity to issues of delivery, transition, infection, nutrition, discharge readiness, and parent education that need to be addressed shortly after birth. The Care and Management of the Late Preterm Infant Toolkit is designed to assist every perinatal unit, regardless of level of care, in implementing an organized plan to address the unique physiologic needs and challenges of the late preterm infant.

 

Improving Initial Lung Function

Premature infants with respiratory distress syndrome (RDS) require stabilization of their lung function, starting with resuscitation. While surfactant remains an important part of the treatment for RDS, increased experience with other methods of respiratory care has led CPQCC to revise its previous recommendations regarding prophylactic surfactant use.

Delivery Room Management of the VLBW Infant

The Delivery Room Management Toolkit provides guidelines for the management of all infants requiring resuscitation following delivery, especially those that are very low birth weight. The smallest and most immature infants have unique requirements to ensure an effective transition from fetal to extrauterine life. These infants have immature organ systems, and without appropriate preparation and intervention can develop severe degrees of hypothermia and respiratory failure that can significantly increase mortality and morbidity.

Antenatal Corticosteroid Therapy

Following the National Institute for Health (NIH) consensus statements on antenatal corticosteroid use in 1994 and 2000, CPQCC’s Antenatal Corticosteroid Therapy Toolkit (“ANS Toolkit”) advocates that all pregnant women between 24 and 34 weeks gestation who are at risk of preterm delivery within 7 days should be treated with corticosteroids. 

Postnatal Steroid Administration

The Postnatal Steroid Administration Toolkit lays out best practices for decreasing chronic lung disease among VLBW infants. Rather than promoting adoption of a specific clinical practice, the Postnatal Steroid Administration Toolkit advocates for abandoning the use of postnatal steroids for treatment of chronic lung disease and hypotension in neonates. Postnatal steroids have been found to have significant effects on pulmonary and cardiovascular status, multiple acute side effects, and the potential for serious adverse effects on long-term outcomes.

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