Infants with severe bronchopulmonary dysplasia-associated pulmonary hypertension have increased morbidity and mortality through 1 year of corrected age. This highlights the need for improved diagnostic practices and prospective studies evaluating treatments for this high-risk population.

The Children's Hospitals Neonatal Consortium is a multicenter collaboration of leaders from 27 regional neonatal intensive care units (NICUs) who partnered with the Children's Hospital Association to develop the Children's Hospitals Neonatal Database (CHND), launched in 2010. The purpose of this report is to provide a first summary of the population of infants cared for in these NICUs, including representative diagnoses and short-term outcomes, as well as to characterize the participating NICUs and institutions. During the first 2 1/2 years of data collection, 40910 infants were eligible. Few were born inside these hospitals (2.8%) and the median gestational age at birth was 36 weeks. Surgical intervention (32%) was common; however, mortality (5.6%) was infrequent. Initial queries into diagnosis-specific inter-center variation in care practices and short-term outcomes, including length of stay, showed striking differences. The CHND provides a contemporary, national benchmark of short-term outcomes for infants with uncommon neonatal illnesses. These data will be valuable in counseling families and for conducting observational studies, clinical trials and collaborative quality improvement initiatives.

Within this large contemporary cohort of newborns with perinatal HIE, the application of therapeutic hypothermia and associated neurodiagnostic studies appear to have expanded relative to reported clinical trials. Although seizure incidence and mortality were lower compared with those reported in the trials, it is unclear whether this represented improved outcomes or therapeutic drift with the treatment of milder disease.

ICV in D/T is apparent among infants with sBPD. These results highlight that the indications for tracheostomy (and subsequent chronic ventilation) remain uncertain.

Drs Piazza, Pallotto, and Brozanski in collaboration provided leadership for the design and analytics of the collaborative; and drafted, reviewed, and revised the manuscript. Ms Zaniletti and Mr Provost provided data analytics and critically reviewed the manuscript. All authors participated in the design and management of the collaborative, approved the fi nal manuscript as submitted, and agreed to be accountable for all aspects of the work. DOI: 10.1542/peds.2014-3642Accepted for publication Sep 21, 2015 Address correspondence to Anthony J. Piazza, MD, Department of Pediatrics, Division of Neonatal Medicine, Emory School of Medicine, 2015 Uppergate Rd, Atlanta, GA 30322. E-mail: apiazza@ emory.edu PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).Health care-associated infections (HAIs) are a burden to patients and the health care system. It is estimated that up to 50% of HAIs are preventable. 1,2 In 2002, however, HAIs in US hospitals reportedly reached ∼1.7 million, with >33 000 HAIs among infants in high-risk nurseries. 3 Central line-associated bloodstream infections (CLABSIs) have the highest cost per HAI and contribute to significant morbidities, mortality, and length of stay in the adult, pediatric, and neonatal populations. [4][5][6] The overall direct annual cost of US HAIs ranges from $35.7 to $45 billion for inpatient hospital services. 7 Although the actual cost of CLABSIs varies, the attributable cost to care is up to $69 000 per event. [7][8][9][10][11] Despite the risks with their use, central venous catheters (CVCs) play an integral role in modern health care. 12 The need for CVCs is particularly important in children's hospital NICUs for patients who abstract OBJECTIVE: Reduce central line-associated bloodstream infection (CLABSI) rates 15% over 12 months in children's hospital NICUs. Use orchestrated testing as an approach to identify important CLABSI prevention practices. METHODS:Literature review, expert opinion, and benchmarking were used to develop clinical practice recommendations for central line care. Four existing CLABSI prevention strategies (tubing change technique, hub care monitoring, central venous catheter access limitation, and central venous catheter removal monitoring) were identified for study. We compared the change in CLABSI rates from baseline throughout the study period in 17 participating centers. Using orchestrated testing, centers were then placed into 1 of 8 test groups to identify which prevention practices had the greatest impact on CLABSI reduction. RESULTS:CLABSI rates decreased by 19.28% from 1.333 to 1.076 per 1000 line-days. Six of the 8 test groups and 14 of the 17 centers had decreased infection rates; 16 of the 17 centers achieved >75% compliance with process measures. Hub scrub compliance monitoring, when used in combination with sterile tubing change, decreased CLABSI rates by 1.25 per 1000 line-days. CONCLUSIONS:This multicenter improvement collaborative achieved a decrease in CLABSI rates. Orchestrated testing identified infection prev...