Skip to main content

Quality of Neonatal Intensive Care and Outcome for High-Risk Newborn Infants

  • Living reference work entry
  • First Online:
  • 289 Accesses

Abstract

It is generally accepted that neonatal outcome is related to the quality of care an infant receives, and therefore it should be closely monitored in order to improve outcome. Quality in neonatal care is a complex subject, but improving quality is a goal to which all neonatologists should aspire. Ongoing quality assessment needs to be implemented in order to improve care such as audit, benchmarking, and confidential enquiries, which are discussed below. Traditional measures of outcome such as death, neurodevelopmental status, and chronic lung disease are also discussed in detail later in this chapter. Improving quality of care can additionally be achieved by implementing modern, effective, evidence-based methods of knowledge translation in order to increase the use of evidence-based healthcare.

This is a preview of subscription content, log in via an institution.

References

  • Acolet D (2008) Quality of neonatal care and outcome. Arch Dis Child Fetal Neonatal Ed 93:F69–F73

    Article  CAS  PubMed  Google Scholar 

  • Acolet D, Allen E, Houston R, Elbourne D (2008) The Bliss Cluster randomised controlled trial of the effect of “active dissemination of information” on the standards of care for premature babies in England (BEADI). Perinatal Medicine Meeting, Harrogate, UK, June 2008

    Google Scholar 

  • Alexander GR, Kogan M, Bader D et al (2003) US birth weight/gestational age-specific neonatal mortality: 1995–1997 rates for whites, hispanics and blacks. Pediatrics 111:e61–e66

    Article  PubMed  PubMed Central  Google Scholar 

  • Ananth C, Vintzileos A (2008) Epidemiology of preterm birth and its clinical subtypes. J Matern Fetal Neonatal Med 21:289–295

    Article  PubMed  Google Scholar 

  • Ancel PY, Goffinet F, Kuhn P et al (2015) Survival and morbidity of preterm children born at 22 weeks through 34 weeks’ gestation in France in 2011: results of the EPIPAGE-2 cohort study. JAMA Pediatr Mar 169(3):230–238

    Article  Google Scholar 

  • Baker CD, Lorimer AR (2000) Cardiology: the development of a managed clinical network. BMJ 321:1152–1153

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Bassler D, Stoll BJ, Schmidt B et al (2009) Using a count of neonatal morbidities to predict poor outcome in extremely low birth weight infants: added role of neonatal infection. Pediatrics 123(1):313–318. doi:10.1542/peds.2008-0377

    Article  PubMed  PubMed Central  Google Scholar 

  • Batalden PB, Davidoff F (2007) What is “quality improvement” and how can it transform healthcare? Qual Saf Health Care 16:2–3

    Article  PubMed  PubMed Central  Google Scholar 

  • Beck S, Wojdyla D, Say L et al (2010) The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bulletin of the World Health Organization 88:31–38

    Article  PubMed  Google Scholar 

  • Berger TM, Steurer MA, Woerner A et al (2012) Trends and centre-to-centre variability in survival rates of very preterm infants (<32 weeks) over a 10-year-period in Switzerland. Arch Dis Child Fetal Neonatal Ed 97(5):F323–F328

    Article  PubMed  Google Scholar 

  • Berrington JE, Hearn RI, Bythell M et al (2012) Deaths in preterm infants: changing pathology over 2 decades. J Pediatr 160(1):49–53

    Article  PubMed  Google Scholar 

  • Blencowe H, Cousens S, Oestergaard MZ et al (2012) National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 379(9832):2162–2172

    Article  PubMed  Google Scholar 

  • Boyle EM, Johnson S, Manketlow B et al (2015) Neonatal outcomes and delivery of care for infants born late preterm or moderately preterm: a prospective population-based study. Arch Dis Child Fetal Neonatal Ed 100(6):F479–F485

    Article  PubMed  PubMed Central  Google Scholar 

  • Branum AM, Schoendorf KC (2002) Changing patterns of low birthweight and preterm birth in the United States, 1981–98. Paediatr Perinat Epidemiol 16:8–15

    Article  PubMed  Google Scholar 

  • Chang HH, Larson J, Blencowe H et al (2013) Preventing preterm births: analysis of trends and potential reductions with interventions in 39 countries with very high human development index. Lancet 381(9862):223–234

    Article  PubMed  Google Scholar 

  • Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI) (2003) Project 27/28. An enquiry into quality of care and its effect on the survival of babies born at 27–28 weeks. The Stationary Office, London

    Google Scholar 

  • Costeloe K, Hennessy E, Gibson A et al (2000) The EPICure study: outcomes to discharge from hospital for infants born at the threshold of viability. Pediatrics 106:659–671

    Article  CAS  PubMed  Google Scholar 

  • Costeloe LK, Hennessy EM, Haider S et al (2012) Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies). BMJ 345, e7976

    Article  PubMed  PubMed Central  Google Scholar 

  • Costeloe K, Hardy P, Juszczak E et al (2016) Bifidobacterium breve BBG-001 in very preterm infants: a randomised controlled phase 3 trial. Lancet 387(10019):649–660

    Article  PubMed  Google Scholar 

  • Craig ED, Thompson JMD, Mitchell EA et al (2002) Socioeconomic status and preterm birth: New Zealand trends, 1980 to 1999. Arch Dis Child Fetal Neonatal Ed 86:F142–F146

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Cropper S, Hopper A, Spencer SA, Dodd K (2002) Managed clinical networks. Arch Dis Child 87:1–4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Dargaville PA, Aiyappan A, Cornelius A (2011) Preliminary evaluation of a new technique of minimally invasive surfactant therapy. Arch Dis Child Fetal Neonatal Ed 96:F243–F248

    Article  PubMed  Google Scholar 

  • de Kleine MJ, Lya den Ouden AL, Kollée LA et al (2007) Lower mortality but higher neonatal morbidity over a decade in very preterm infants. Paediatr Perinat Epidemiol 21:15–25

    Article  PubMed  Google Scholar 

  • Demissie K, Rhoads GG, Ananth CV et al (2001) Trends in preterm birth and neonatal mortality among blacks and whites in the United States from 1989 to 1997. Am J Epidemiol 154:307–315

    Article  CAS  PubMed  Google Scholar 

  • Draper ES, Zeitlin J, Field DJ et al (2007) Mortality patterns among very preterm babies: a comparative analysis of two European regions in France and England. Arch Dis Child Fetal Neonatal Ed 92:356–360

    Article  Google Scholar 

  • El-Metwally D, Vohr B, Tucker R (2000) Survival and neonatal morbidity at the limits of viability in the mid 1990s: 22 to 25 weeks. J Pediatr 137:616–622

    Article  CAS  PubMed  Google Scholar 

  • Fanaroff AA, Stoll BJ, Wright LL et al (2007) Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol 196:147.e1–e8

    Article  Google Scholar 

  • Field D, Hyman-Taylor P, Bacon C, Draper ES on behalf of MBRRACE-UK (2014) Perinatal confidential enquiry – congenital diaphragmatic hernia. The Infant Mortality and Morbidity Group, Department of Health Sciences, University of Leicester, Leicester

    Google Scholar 

  • Garg P, Abdel-Latif ME, Bolisetty S et al (2010) Perinatal characteristics and outcome of preterm singleton, twin and triplet infants in NSW and the ACT, Australia (1994–2005). Arch Dis Child Fetal Neonatal Ed 95(1):F20–F24

    Article  CAS  PubMed  Google Scholar 

  • Genzel-Boroviczeny O, Macwilliams S, Von Poblotzki M et al (2006) Mortality and major morbidity in premature infants less than 31 weeks gestational age in the decade after introduction of surfactant. Acta Obstet Gynecol Scand 85:68–73

    Article  PubMed  Google Scholar 

  • Hack M, Fanaroff AA (2005) Outcomes of children of extremely low birthweight and gestational age in the 1990s. Semin Neonatol 5:89–106

    Article  Google Scholar 

  • Hakansson S, Farooqi A, Holmgren PA et al (2004) Proactive management promotes outcome in extremely preterm infants: a population based comparison of two perinatal management strategies. Pediatrics 114:58–64

    Article  PubMed  Google Scholar 

  • Hintz SR, Slovis T, Bulas D et al (2007) Interobserver reliability and accuracy of cranial ultrasound scanning interpretation in premature infants. J Pediatr 150:592–596

    Article  PubMed  PubMed Central  Google Scholar 

  • Horbar JD (1995) The Vermont-Oxford Neonatal Network: integrating research and clinical practice to improve the quality of medical care. Semin Perinatol 19:124–131

    Article  CAS  PubMed  Google Scholar 

  • Horbar JD (1999) The Vermont Oxford Network: evidence-based quality improvement for neonatology. Pediatrics 103:350–359

    CAS  PubMed  Google Scholar 

  • Horbar JD, Badger GJ, Carpenter JH (2002) Trends in mortality and morbidity for very low birth weight infants, 1991–1999. Pediatrics 110:143–150

    Article  PubMed  Google Scholar 

  • Horbar JD, Carpenter JH, Buzas J et al (2004) Collaborative quality improvement to promote evidence based-surfactant for preterm infants: a cluster randomised trial. BMJ 329:1004

    Article  PubMed  PubMed Central  Google Scholar 

  • Hoyert DL, Freedman MA, Strobino DM et al (2001) Annual summary of vital statistics: 2000. Pediatrics 108:1241–1255

    Article  CAS  PubMed  Google Scholar 

  • Institute of Medicine (2001) Crossing the quality chasm: a new health system for the 21st century. National Academy Press, Washington DC

    Google Scholar 

  • Institute of Medicine (IOM) (2001) Crossing the quality chasm: a new health system for the 21st century. National Academy Press, Washington, DC

    Google Scholar 

  • Jarjour IT (2015) Neurodevelopmental outcome after extreme prematurity: a review of the literature. Pediatr Neurol 52(2):143–152

    Article  PubMed  Google Scholar 

  • Jobe AH (2011) The new bronchopulmonary dysplasia. Curr Opin Pediatr 23(2):167–172

    Article  PubMed  PubMed Central  Google Scholar 

  • Jobe AH, Bancalari E (2001) Bronchopulmonary dysplasia. Am J Respir Crit Care Med 163:1723–1729

    Article  CAS  PubMed  Google Scholar 

  • Johnson S, Marlow N (2011) Preterm birth and childhood psychiatric disorders. Pediatr Res 69:11R–18R

    Article  PubMed  Google Scholar 

  • Johnson S, Hennessy E, Smith R et al (2009) Academic attainment and special educational needs in extremely preterm children at 11 years of age: the EPICure study. Arch Dis Child Fetal Neonatal Ed 94(4):F283–F289

    Article  CAS  PubMed  Google Scholar 

  • Kribs A, Roll C, Göpel W (2015) Nonintubated surfactant application vs conventional therapy in extremely preterm infants: a randomized clinical trial. JAMA Pediatr 169(8):723–730

    Article  PubMed  Google Scholar 

  • Linder N, Haskin O, Levit O et al (2003) Risk factors for intraventricular haemorrhage in very low birth weight premature infants: a retrospective case control study. Pediatrics 111:e590–e595

    Article  PubMed  Google Scholar 

  • Mainz J (2003) Developing evidence-based clinical indicators: a state of the art methods primer. Int J Qual Health Care 15(1):i5–i11

    Article  PubMed  Google Scholar 

  • Markestad T, Kaaresen PI, Ronnestad A et al (2005) Early death, morbidity and need of treatment among extremely premature infants. Pediatrics 115:1289–1298

    Article  PubMed  Google Scholar 

  • Marlow N, Gill AB (2007) Establishing neonatal networks: the reality. Arch Dis Child Fetal Neonatal Ed 92:F137–F142

    Article  PubMed  Google Scholar 

  • McIntosh N, Youle L (2008) National Neonatal Audit Project annual report. Royal College of Paediatrics and Child Health

    Google Scholar 

  • Moore T, Hennessy EM, Myles J (2012) Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies. BMJ 345, e7961

    Article  PubMed  PubMed Central  Google Scholar 

  • Morley CJ, Davis PG, Doyle L et al (2008) Nasal CPAP or intubation at birth for very preterm infants. NEJM 358:700–708

    Article  CAS  PubMed  Google Scholar 

  • Nguyen TP, Amon E, Al-Hosni M et al (2012) “Early” versus “late” 23-week infant outcomes. Am J Obstet Gynecol 207(3):226.e1–6

    Article  Google Scholar 

  • Peerzada JM, Schollin J, Hakansson S (2006) Delivery room decision making for extremely preterm infants in Sweden. Pediatrics 117:1988–1995

    Article  PubMed  Google Scholar 

  • Petrou S, Johnson S, Wolke D et al (2013) The association between neurodevelopmental disability and economic outcomes during mid-childhood. Child Care Health Dev 39(3):345–347

    Article  CAS  PubMed  Google Scholar 

  • Productive Time Delivery Board and NHS Benchmarking Club (2006) Delivering quality and value: focus on benchmarking. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4139062

  • Provonost P, Needham D et al (2006) An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 355:2725–2732

    Article  Google Scholar 

  • Richardus JH, Graafmans WC, Verloove-Vanhorick SP, Mackenbach JP (2003) Differences in perinatal mortality and suboptimal care between 10 European regions: results of an international audit. BJOG 110:97–105

    Article  PubMed  Google Scholar 

  • Roberts D, Dalziel SR (2006) Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 3, CD004454

    Google Scholar 

  • Rysavy MA, Li L, Bell EF et al (2015) Between-hospital variation in treatment and outcomes in extremely preterm infants. N Engl J Med 372(19):1801–1811

    Article  PubMed  PubMed Central  Google Scholar 

  • Schmidt B, Asztalos EV, Roberts RS et al (2003) Impact of bronchopulmonary dysplasia, brain injury, and severe retinopathy on the outcome of extremely low-birth-weight infants at 18 months. JAMA 289:1124–1129

    Article  PubMed  Google Scholar 

  • Slattery M, Morrison J (2002) Preterm delivery. Lancet 360:1489–1497

    Article  PubMed  Google Scholar 

  • Smith LK, Draper ES, Manktelow BN et al (2007) Socioeconomic inequalities in very preterm birth rates. Arch Dis Child Fetal Neonatal Ed 92:F11–F14

    Article  CAS  PubMed  Google Scholar 

  • Stevens TP, Harrington EW, Blennow M et al (2007) Early surfactant administration with brief ventilation vs. selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome. Cochrane Database Syst Rev 4, CD003063

    Google Scholar 

  • Stevens TP, Finer NN, Carlo WA et al (2014) Respiratory outcomes of the surfactant positive pressure and oximetry randomized trial (SUPPORT). J Pediatr 165(2):240–249

    Article  PubMed  PubMed Central  Google Scholar 

  • Stoelhurst GM, Rijken M, Martens SE et al (2005) Changes in neonatology: Comparison of two cohorts of very preterm infants (gestational age <32 weeks): the project on preterm and small for gestational age infants 1983 and the Leiden follow up project on prematurity 1996–1997. Pediatrics 115:396–404

    Article  Google Scholar 

  • Stoll BJ, Hansen NI, Bell EF et al (2010) Neonatal outcomes of extremely preterm infants from the NICHD neonatal research network. Pediatrics 126(3):443–456

    Article  PubMed  PubMed Central  Google Scholar 

  • Sweet DG, Carnielli V, Greisen G et al (2013) European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants – 2013 update. Neonatology 103:353–368

    Article  PubMed  Google Scholar 

  • Taylor HG, Klein N, Minich NM et al (2000) Middle-school-age outcomes in children with very low birthweight. Child Dev 71:1495–1511

    Article  CAS  PubMed  Google Scholar 

  • The Victorian Infant Collaborative Study Group (1997) Outcome at 2 years of children 23–27 weeks’ gestation born in Victoria in 1991–2. J Pediatr Child Health 33:161–165

    Article  Google Scholar 

  • Topp M, Huusom LD, Langhoff-Roos J et al (2004) Multiple birth and cerebral palsy in Europe: a multicenter study. Acta Obstet Gynecol Scand 83(6):548–553

    Article  PubMed  Google Scholar 

  • Wolke D, Strauss VY, Johnson S et al (2015) Universal gestational age effects on cognitive and basic mathematic processing: 2 cohorts in 2 countries. Pediatrics 166(6):1410–1416

    Article  Google Scholar 

  • Wood NS, Costeloe K, Gibson AT et al (2005) The EPICure study: associations and antecedents of neurological and developmental disability at 30 months of age following extremely preterm birth. Arch Dis Child Fetal Neonatal Ed 90:F134–F140

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Yeo KT, Lee QY, Quek WS et al (2015) Trends in morbidity and mortality of extremely preterm multiple gestation newborns. Pediatrics 136(2):263–271

    Article  PubMed  Google Scholar 

  • Zeitlin J, Draper ES, Kollee L et al (2008) Differences in rates and short-term outcome of live births before 32 weeks of gestation in Europe in 2003: results from the MOSAIC cohort. Pediatrics 121:e936–e944

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Liz McKechnie .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this entry

Cite this entry

McKechnie, L., Johnson, K. (2016). Quality of Neonatal Intensive Care and Outcome for High-Risk Newborn Infants. In: Buonocore, G., Bracci, R., Weindling, M. (eds) Neonatology. Springer, Cham. https://doi.org/10.1007/978-3-319-18159-2_165-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-18159-2_165-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Online ISBN: 978-3-319-18159-2

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics