Morbidity-free survival in extremely premature infants after changes of clinical practices according to evidence-based guidelines: a quality improvement uncontrolled before-after study in a neonatal intensive care unit.

Abstract

The evolution of our clinical practices appears to have positive effects on global and SNM-free survival and seems to have reduced the incidence of nosocomial infections. • Using global survival and severe neonatal morbidity-free survival rates allows to compare inter- and intra-team critical care practices in neonatal intensive care units. • Major changes in clinical procedures, in accordance to recent guidelines, were implemented after the restructuration of the medical team in 2018, with the expected objective of improving morbidity and mortality of extremely premature infants (EPI) in our unit. • After the changes, EPI exhibit a lower composite endpoint of "death or severe neonatal morbidity (SNM)" and were more frequently free of any SNM indicators concomitantly with a shorter median duration of invasive ventilation and parenteral nutrition. • The evolution of local clinical practices may positively impact mortality and morbidity within a few years.