ArticlePediatrics2022
A Quality Improvement Bundle to Improve Outcomes in Extremely Preterm Infants in the First Week.
Article in Pediatrics, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.
- Pooled it
- Total Fluid Administration and Weight Loss during the First 2 Weeks in Infants Randomized to Early Enteral Feeding after Extremely Preterm Birth.Neonatology · 2023Trial
- Early fluid status and severe intraventricular hemorrhage or death in extremely preterm infants.Pediatric nephrology (Berlin, Germany) · 2026Article
- Weight changes and variability in the first week of life: associations with mortality in extremely preterm newborns.Pediatric nephrology (Berlin, Germany) · 2026Article
- Acute kidney injury and early mortality in extremely preterm neonates born at 22-27 weeks gestation.Pediatric nephrology (Berlin, Germany) · 2026Article
- Transcutaneous carbon dioxide monitoring: ready to be standard of care?Pediatric research · 2026Article
- Survival without major morbidity in very preterm infants (<32 weeks' gestation): prevalence, temporal trends, and associated factors in a single-center retrospective cohort.Frontiers in pediatrics · 2026Article
- Golden hour(s) quality improvement protocols and their effect on outcomes in preterm infants ≤ 32 weeks of gestation: a scoping review.BMC pediatrics · 2025Article
- Article
- Exploring the predictive value of pH in stratified mortality risk of NEC patients undergoing surgery: a retrospective study based on the PIC database.Translational pediatrics · 2025Article
- Sustained Reduction in Severe Intraventricular Hemorrhage in Micropremature Infants: A Quality Improvement Intervention.Children (Basel, Switzerland) · 2025Article
- Intraventricular Hemorrhage and Survival, Multimorbidity, and Neurodevelopment.JAMA network open · 2025Article
- The performance of the practices associated with the occurrence of severe intraventricular hemorrhage in the very premature infants: data analysis from the Chinese neonatal network.BMC pediatrics · 2024Article
- Respiratory support strategies in the management of severe, longstanding bronchopulmonary dysplasia.Frontiers in pediatrics · 2022Review
Corrections and comments
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Authors and funding
11 authors at 3 institutions in 1 country.
Funding
Abstract
objectivesOur objective with this quality improvement initiative was to reduce rates of severe intracranial hemorrhage (ICH) or death in the first week after birth among extremely preterm infants.
methodsThe quality improvement initiative was conducted from April 2014 to September 2020 at the University of Alabama at Birmingham's NICU. All actively treated inborn extremely preterm infants without congenital anomalies from 22 + 0/7 to 27 + 6/7 weeks' gestation with a birth weight ≥400 g were included. The primary outcome was severe ICH or death in the first 7 days after birth. Balancing measures included rates of acute kidney injury and spontaneous intestinal perforation. Outcome and process measure data were analyzed by using p-charts.
resultsWe studied 820 infants with a mean gestational age of 25 + 3/7 weeks and median birth weight of 744 g. The rate of severe ICH or death in the first week after birth decreased from the baseline rate of 27.4% to 15.0%. The rate of severe ICH decreased from a baseline rate of 16.4% to 10.0%. Special cause variation in the rate of severe ICH or death in the first week after birth was observed corresponding with improvement in carbon dioxide and pH targeting, compliance with delayed cord clamping, and expanded use of indomethacin prophylaxis.
conclusionsImplementation of a bundle of evidence-based potentially better practices by using specific electronic order sets was associated with a lower rate of severe ICH or death in the first week among extremely preterm infants.
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