Quality improvement project designed to reduce disproportionate growth in extremely low gestational age neonates: cognitive neurodevelopmental outcome at 18–41 months

Abstract

Objective To assess if the adjusted odds of low composite cognitive Bayley-III scores changed after implementing a singleinstitution quality improvement (QI) project designed to decrease discharge Z-scores for weight, body mass index (BMI), and weight-for-length, but not length or fronto-occipital circumference (FOC) in infants 23-28 weeks gestational age (GA). Methods Compare Bayley-III outcomes at ≥18 months corrected age (postnatal age adjusted for prematurity) in infants tested before (Epoch-1) and after (Epoch-2) QI implementation. Results Bayley testing was available in 134/156 infants (86%) in Epoch-1 and 139/175 (79%) in Epoch-2. There was no change in frequency of low (<85) cognitive score (p = 0.5) or in median cognitive scores (80 in Epoch-1 vs. 85 Epoch-2, p = 0.35). The adjusted odds of low cognitive scores was not different between Epochs. Conclusion No change in cognitive outcome at ≥18 months corrected age was observed after implementing a QI project designed to reduce discharge weight-for-length disproportion in very preterm infants.

Relationship between Ventricular Size on Latest Ultrasonogram and the Bayley Scores ≥ 18 Months in Extremely Low Gestational Age Neonates: A Retrospective Cohort Study

“…Infants who completed BSID testing at ≥18 months adjusted age had lower mean GA and Z -scores for birth weight, length, and frontooccipital circumference than those with incomplete BSID testing. 3…”

“…This was a retrospective cohort study. It was a secondary analysis of data collected during a single-center quality improvement (QI) project [2,3] designed to reduce discharge weight-forlength disproportion in very preterm infants. No change in cognitive outcome at months corrected age (postnatal age adjusted for prematurity) was observed after implementing the QI project [3].…”

“…No change in cognitive outcome at 18 to 41 months corrected age (postnatal age adjusted for prematurity) was observed after implementing the QI project. 3…”

“…The original study population of the QI project included 331 infants born at 23 0/7 to 28 6/7 weeks of gestational age (GA) at Parkland Hospital between July 2012 and October 2017 and discharged from the neonatal intensive care unit (NICU). 2,3 The current study included the subset of 270 infants who had an HUS completed before discharge and BSID testing at 18 to 41 months adjusted age.…”