Improving survival in the 22-24 weeks gestation newborn: A single center quality improvement initiative

Objective: To review the impact of a quality improvement initiative upon survival and key in-house morbidities. Study Design: A prospective cohort with retrospective baseline, quality improvement initiative, with key drivers for improvement focused on perinatal, delivery room and neonatal care management, comparing 2016-2019 (Baseline) and 2020-2023 (Intervention). Results: Survival rates (discharge to home) improved at 22 weeks (14.3%, 71.4%; p=0.002), and at 22-24 weeks (60.2%, 76.9%; P=0.018). 22-24 weeks one and five-minute APGAR scores (2 (1-4), 3 (2-5); P=0.031) improved. At 22-weeks, there was an increase in use of post-natal steroids (11.1%, 63.2%; P=0.016). At 22-24 weeks, there was an increase in the placement of a gastrostomy tube (9.1%, 20.2%; P=0.045), and tracheostomy tube (0%,9%; P=0.008). Conclusion: A single center experience implementing a quality improvement initiative that employed active management, and updating our standardized care guidelines, demonstrated improved survival rates at 22-weeks and combined 22-24 weeks gestation. Key morbidities remain high and unchanged, with an increased need for gastrostomy and tracheostomy tube placement.