CHOC’s Small Baby Unit Improves Quality and Outcomes in Extremely Low Birth Weight Infants

CHOC Children’s clinicians have determined that a dedicated Small Baby Unit (SBU) improves quality and outcomes in extremely low birth weight (ELBW) infants (babies born at 28 weeks gestation or less and weighing less than 1,000 grams), according to results of an article they published in Pediatrics[i].

“In recent years, the survival rates for ELBW infants have improved with the latest advances in neonatal intensive care, but many are still released from the hospital with significant challenges, including neurodevelopmental delays and/or chronic medical problems,” said Mindy Morris, DNP, the SBU program coordinator and co-author. “Our goal was to improve these outcomes by utilizing a dedicated team with expertise in the care of this population.”

The objective of the CHOC neonatology team was to cohort ELBW infants in a single location physically separated from the main Neonatal Intensive Care Unit (NICU), and to recognize that progressive changes in culture were essential for successfully shifting the practice model. This space became the 12-bed SBU, which consisted of four individual patient rooms, two of which are surgical suites, and three four-bed pods. Different from a traditional NICU, this smaller unit allows for a darker, quieter environment that encourages developmentally supportive care. The goal is to create an environment that respects and supports the physiologic needs of the baby to grow and develop after being born so prematurely. Grouping this population also provides parents an opportunity to form strong bonds with other families sharing similar experiences.

Outcomes from the two years before and four years after opening the SBU in March 2010:

  • Reduction in chronic lung disease from 47.5% to 35.4%.
  • Rate of hospital-acquired infection decreased from 39.3% to 19.4%.
  • Infants being discharged with growth restriction (combined weight and head circumference, < 10th percentile) decreased from 62.3% to 37.3%.
  • Reduced resource utilization was demonstrated as the mean number per patient of laboratory tests decreased from 224 to 82 and radiographs decreased from 45 to 22.

The research found that improved outcomes in ELBW infants can be achieved by changing the culture of the practice. The successful outcomes likely reflect the benefits of consistency in practice by a dedicated team that gained expertise in the care of this population in a separate developmentally appropriate location. Additionally, there was a reduction in illness and complications among infants after leaving the SBU. Engaging the team on an ongoing basis can sustain improved outcomes.

[i] Morris M., et al., Small Baby Unit Improves Quality and Outcomes in Extremely Low Birth Weight Infants, Pediatrics (2015), http://pediatrics.aappublications.org/content/early/2015/09/01/peds.2014-3918