Quality Improvement Analysis of Developmental Care in Infants Less Than 1500 Grams at Birth

Abstract

The study evaluated the effect of developmental care (DC) on short-term outcome, weight gain, and length of stay in very low-birth-weight infants (1000–1499 grams) and extremely low-birth-weight infants (<1000 grams at birth). The infants were cared for in the neonatal intensive care unit (NICU) at the University Hospital in Cincinnati. It was hypothesized that providing consistent DC to all babies in the NICU weighing 1500 grams or less at birth would increase weight gain and decrease length of stay. Data for both cohorts, predevelopmental care (preDC) and postdevelopmental care (postDC) were collected prospectively as part of the National Institutes of Health Neonatal NICU Research Network generic database on babies less than 1500 grams. This database included all variables studied and used in both cohorts. The study consisted of a pre-DC historic control and post-DC treatment group. The postDC period started 3 months after the entire staff had undergone a 4-day focused educational program on DC. This was done so that the data collected for the postDC group would occur after the initial learning curve for DC in the NICU. This study was carried out in a 50-bed level III NICU in a university teaching hospital setting. Infants weighing 1500 grams or less at birth between July of 1998 and July of 2002 were included. This population was divided into two groups: the preDC group (July 1998-July 2000) and the postDC group (2000–2002). Subgroups were then established by birth weight, less than 1000 and 1000 to 1499 grams, and the second subgroup used to separate groups less than 28 weeks gestational age and greater than 28 weeks gestational age. The total study population consisted of 292 infants. There was a statistically significant increase in weight at 36 weeks of age in the postDC period as compared to the preDC group for both the extremely low-birth-weight and very low-birth-weight groups (P < .05). The postDC group had a significant increase in the percentage of infants discharged by 40 weeks postconceptional age (P < .01). In conclusion, the successful introduction of a broad practice–based DC program in a university hospital NICU setting is described. This program coincided with significant improvement in weight gain and early discharge in preterm infants less than 1500 grams at birth. This is the first study to incorporate bubble continuous positive airway pressure into a DC regimen and the first National Institutes of Health Neonatal Network site to document positive benefits from the widespread implementation of DC practice across a single NICU.