Assessment of neonatal care quality for infants born from 24 to 31 weeks: insights from the Baby Monitor scoring system in Shenzhen

The Baby Monitor scoring system, developed in U.S. neonatal networks, evaluates care quality through internationally accepted indicators, but its applicability in Chinese NICUs has not been assessed. This study provides the first regional benchmark using this system within the Shenzhen Neonatal Data Network (SNDN) for infants born before 32 weeks’ gestation. A retrospective analysis was conducted on data from preterm infants admitted between January 1, 2022, and December 31, 2023. The Baby Monitor scoring system assessed NICU performance using eight key indicators: survival rate, antenatal steroid administration, admission hypothermia, pneumothorax, hospital-acquired infections, chronic lung disease (CLD), growth velocity, and any breastfeeding at discharge. Risk-adjusted z-scores were calculated for each indicator to compare NICU performance. A total of 1,267 preterm infants were included, with a median gestational age of 30.0 weeks and a median birth weight of 1,280 g. Significant variability was observed in individual quality indicators. Risk-adjusted composite scores did not differ significantly, largely due to overlapping confidence intervals reflecting limited unit-level sample sizes and offsetting performance across individual indicators. The overall unadjusted survival rate was 93.8%, with antenatal steroid use at 89.6%. Moderate to severe hypothermia occurred in 22.2% of cases, pneumothorax in 1.8%, and hospital-acquired infections in 9.3%. CLD incidence was 21.6%, and breastfeeding at discharge was achieved in 57.8% of infants. High growth velocity was observed in 80.6% of cases. The Baby Monitor system effectively profiled care quality across SNDN NICUs, identifying actionable domains such as hypothermia prevention and breastfeeding support. Network-wide sharing of practices from high-performing units—for example, strict thermal care protocols and dedicated lactation support—could reduce inter-unit variability. This baseline will inform targeted quality improvement cycles within the SNDN.