Implementation of a Minimal Stimulation Guideline for Infants Less than 29 Weeks Gestation for the First Week of Life

Background:The prevalence of prematurity is significant, with 1 in 8 live births occurring before 37 weeks gestation. More infants are surviving who are born between 22-28 weeks gestation. These infants are at high risk for adverse neurodevelopmental outcomes. Steps taken during the first week of life can impact premature infants' temperature stability and intraventricular hemorrhage rates, leading to better overall outcomes. Guidelines implemented throughout the country for infants born less than 29 weeks gestation for the first week create consistency of care, which leads to better outcomes. Methods: A quality improvement project was developed and implemented in an urban hospital that lacked a guideline for infants born less than 29 weeks gestation. Staff were surveyed on their knowledge about care for these infants. A guideline was created through literature review and implemented along with an educational component. Staff were re-surveyed after education and implementation of the guideline to assess the impact of the intervention. Patient data was also collected for 3 months pre- and post-implementation on intraventricular hemorrhage rates and temperature stability during the first week of life on infants born less than 29 weeks gestation. Results: Post-intervention, the survey from 22 staff members found that education on the guideline increased knowledge and understanding on 4 of 6 aspects. 100% of the staff surveyed responded that their future care of infants born less than 29 weeks gestation would change. Patient data for 3 months pre- and post-guideline was too small to show statistical significance.Conclusions: The project was shown to be valuable to staff who care for infants born less than 29 weeks gestation. The guideline and educational component will continue on the unit. Longer-term monitoring will be required to determine neurologic and temperature stability outcomes.