This study evaluated progress to publication of pediatric quality improvement (QI) projects initially presented as national conference abstracts, according to project findings and other characteristics. QI abstracts were identified among presentations at the 2010-2015 American Academy of Pediatrics National Conference & Exhibition, and publications were tracked through June 2018. Positive findings (improvement on at least 1 quantitative project outcome), interventions, and analyses were correlated with journal publication. Of 142 abstracts, 128 (90%) reported positive findings. Forty-nine positive abstracts and 3 abstracts reporting negative results resulted in publication (38% vs 21%, respectively; P = .256). Median time to publication was 1.2 years for projects with positive findings, compared to >3 years for abstracts with negative findings ( P = .029). Ninety percent of abstracts reported positive findings, and these abstracts progressed to publication more quickly. Overcoming publication bias for pediatric QI projects may enhance selection of promising interventions as new projects are designed.

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Introduction: Hypocarbia in neonates increases the risk of poor neurodevelopmental outcomes. Volume-targeted ventilation (VTV) is associated with decreased hypocarbia and other respiratory morbidities. We noticed a high incidence of hypocarbia in extremely low birth weight (ELBW; <1,000 g) neonates in our Neonatal Intensive Care Unit. Thus, we undertook a quality improvement project to decrease the incidence of hypocarbia (the occurrence of PCO 2 < 35 mm Hg) in ELBW neonates during the first week of life by 50% over 1 year. Methods: Our major interventions were employing VTV as the primary mode of mechanical ventilation in neonates less than 28 weeks of gestation or ELBW at birth and increasing staff knowledge regarding hypocarbia. The baseline period spanned May–August 2016. We implemented the interventions in October 2016 and tracked the use of VTV and the incidence of hypocarbia during the first week of life for 12 months. Results: We analyzed data on 28 and 77 patients in the baseline and postintervention periods, respectively. The use of VTV increased from 39% to 65%. However, the incidence of hypocarbia was not reduced (57% preintervention vs. 64% postintervention). In the postintervention cohort, the incidence of hypocarbia was comparable between VTV and other modes (60% vs. 70%; 95% confidence interval: −32%, 12%; P = 0.367), but we noted decreased blood gas sampling and earlier extubation in the VTV group ( P = 0.002 and P = 0.046, respectively). Conclusions: Successfully increasing VTV in our Neonatal Intensive Care Unit did not decrease hypocarbia during the first week of life. However, we observed the safety of VTV and obtained other desirable results.

Introduction. Poorly executed transitions of care in health care systems are associated with safety concerns and patient dissatisfaction. We noticed several problems in the transfer process between our neonatal intensive care unit (NICU) and special care nursery (SCN) and designed this quality improvement project to address them. The aim was to decrease suboptimal transfers from the NICU to the SCN by 50% over 9 months. We defined suboptimal transfers as the discharge of a patient within 3 days of transfer from the NICU to the SCN or the return of a patient to the NICU within 5 days of the transfer. Methods. We formed a multidisciplinary team and collected baseline data from October 2019 to December 2020. Major interventions included implementing a transfer checklist and algorithm. We utilized 3 staff surveys to evaluate the progress of the project. We used statistical process control charts to track project measures over time. Results. Patient demographics and SCN length of stay were similar for the baseline and postintervention periods. We decreased suboptimal transfers over 21 months (January 2021 to September 2022), achieved a significantly increased rate of parent notification before transfers (81% baseline versus 93% postintervention), and increased staff satisfaction with the transfer process (15% baseline versus 43% postintervention). Conclusions. We successfully improved the transfer process from our NICU to the SCN via a quality improvement project. Increased staff satisfaction and the lack of perception of additional burden to the staff from the new process are expected to sustain our results.

Objective To describe a single center’s experience with the management of neonates born at 22 weeks of gestation. Study Design Retrospective review of 18 neonates born alive at 22 weeks GA to 16 mothers (cohort included 2 sets of twins) from January 2017 to December 2020, and admitted to a level IV Neonatal Intensive Care Unit. Data on antenatal management was collected from maternal charts. Results Nine mothers delivered due to preterm labor, 5 due to preterm pre-labor rupture of membranes with intra-amniotic infection, and 2 after antepartum hemorrhage. Fourteen mothers received antenatal counseling, 75% received antenatal steroids (25% received a full course), and 31% delivered via caesarean section in honor of parental wishes. All the neonates were actively resuscitated, with 5 surviving to discharge (28%). All survivors had at least 1 morbidity at discharge. None of the infants who underwent extensive resuscitation including chest compressions, epinephrine administration, or volume expansion survived to discharge. Conclusions Adequate antenatal counseling with personalized decision-making consistent with parental desires is the preferred approach at the limits of viability. Although not evident in this study, antenatal interventions such as corticosteroids may improve outcomes and should be considered for families who desire neonatal resuscitation at 22 weeks.