ArticleBMJ open2025
E-Prem checklist-driven strategy to improve outcomes in extremely preterm and low birth weight infants: a quasi-experimental study at a national referral hospital in Indonesia.
Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesThis study aims to assess how implementing a checklist for managing extremely preterm or extremely low birth weight infants can reduce mortality rates and morbidities.
designA quasi-experimental, before-and-after study.
settingNeonatal intensive care unit at Dr. Cipto Mangunkusumo National General Hospital, a national referral hospital in Indonesia. PARTICIPANT: 86 infants were born at <28 weeks of gestation and/or with birth weight <1000 g. Exclusion criteria were major congenital anomalies incompatible with life. 48 were managed prior to checklist implementation (September 2022-March 2023) and 38 after checklist implementation (April-October 2023).
interventionsImplementation of a modified Canberra Health Services extremely preterm-early management checklist during the initial management of extremely preterm or low birth weight infants, including humidified gas resuscitation, thermal management, early surfactant administration and standardised first-hour care protocols.
main outcome measuresThe primary outcome was the mortality rate. Secondary outcomes included comorbidities such as hypothermia, hypoglycaemia, acidosis, intraventricular haemorrhage (IVH), periventricular leukomalacia (PVL) and retinopathy of prematurity (ROP).
resultsA total of 86 extremely premature and/or extremely low birth weight infants were enrolled, 48 neonates prior to and 38 neonates after the use of the checklist. Baseline characteristics were comparable between groups (median gestational age 27 weeks in both groups, median birth weight 795 g vs 868.5 g, p=0.09). Mortality at discharge showed a non-significant reduction from 52.1% to 47.4% (p=0.664, 0.91, 95% CI 0.64 to 1.30). Significant reductions were observed in IVH (79.2% to 28.9%, p<0.001) and ROP (56.3 to 15.8%, p<0.001). No significant differences were found in hypothermia, hypoglycaemia, acidosis rates or PVL.
conclusionsImplementation of a systematic checklist was associated with significant reductions in IVH and ROP, though mortality reduction was not statistically significant. These findings suggest potential benefits of structured early care protocols, but the observational design limits causal inference.
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