Implementation of The CDC's Developmental Milestone Guideline for Infants Corrected Age 2-4 Months Hospitalized in the NICU

Background: Every year in the United States there are approximately 360,000 babies that are born premature. In the state of Utah that number is approximately 45,700, which is almost 10% of all babies born. Preterm infants are at greater risk for developmental delays. Long lengths of stay in the Newborn Intensive Care Unit (NICU) environment further pre-dispose these infants to greater risk of neurobehavioral problems. Early intervention developmental care is critical to improve long term optimal development for these infants. Sadly, to the deficit of these vulnerable infants, providers and nurses working in the NICU commonly prioritize and focus care on medical and nursing interventions and overlook developmental care. Methods: A quality improvement (QI) project in a level 4 NICU was developed to increase awareness about developmental delay that occurs with this subset of the population and activities that can be performed to assist with this. Staff registered nurses (RNs), patient care techs (PCTs) and Neonatal Nurse Practitioners (NNPs) were assessed by the use of a pre-implementation survey on their knowledge and understanding of the Center for Disease Control and Prevention's (CDC) developmental milestones and tracker usage. A toolkit, which included a flip chart, a milestone checklist based on the CDC's developmental milestones, and a fact sheet with references was created. Staff nurses and PCTs were educated, with the materials in the toolkit and also by PowerPoint presentation at the beside about the use of the toolkit. The toolkit was readily available for staff at the bedside. Post-implementation surveys were sent to staff to determine the effectiveness of this project and to determine what suggestions staff had for its continuance. Checklists were also collected from the bedside for analysis on what activities, if any, staff was able to complete during their shifts. Results: Of the participants in this QI project 42% (n=6) of NNP's and 11% (n=3) of RN's were familiar with the CDC's Developmental Milestones and tracker for Infants. For all participants 66% (n=31) of the time "sometimes" provided developmental care. Post implementation, while the majority of participants continued to "sometimes" provide developmental care for their infants, the percentage of participants that "rarely" or "never" provided developmental care decreased from 13% (n=6) to 0%. Conclusions: Subsequent to real time education and having accessible bedside toolkits, caregivers were supported to provide developmental care and activities for hospitalized infants. Caregivers recognized the value of providing developmental care and activities for hospitalized infants. However, developmental care should be considered in parallel to workload, patient criticality, and staff shortages. Recommendation would be to incorporate developmental care into annual education/skills day, into new hire education, and to continue ongoing reference to CDC's guidelines and national principles.