1 - Adapting a Quality of Care Measure for Moderate and Late Preterm Infants

Poster Number: 1
Publication Number: 1.337

Elizabeth G. Salazar, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Sara C. Handley, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Lucy T. Greenberg, Vermont Oxford Network, Burlington, VT, United States; Erika M. Edwards, Robert Larner, M.D., College of Medicine at the University of Vermont, Burlington, VT, United States; Scott A. Lorch, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States

Background: Representing 80% of preterm births, moderate and late preterm (MLP) infants comprise the majority of NICU patients. MLP (30-36 weeks gestational age [GA]) infants are at increased risk for prematurity-associated complications and mortality compared to term infants. While quality measures exist for very low birth weight (VLBW) and term infants, there are no population-specific quality measures for MLP infants.

Objective: To adapt a quality measure for the MLP population and compare the performance with measures for VLBW infants.

Design/Methods: Using the Vermont Oxford Network all NICU admissions database, we adapted Baby-MONITOR, an established composite quality measure for VLBW infants, for MLP infants. We removed measure components specific to very preterm infants (antenatal steroids, timely retinal exam, chronic lung disease, and growth velocity) and replaced them with extreme length of stay, oxygen at 28 days, and change in weight z-score based on prior literature that demonstrated variation in these measures in MLP infants. We examined Pearson correlation coefficients between the MLP quality measure (MLP-QM) in MLP infants and Baby-MONITOR in extremely/very preterm infants. Correlations were rated as weak (

Results: We studied 376,219 MLP (30-36 wks GA) and 57,595 extremely/very preterm (25-29 wks GA) infants from 465 U.S. hospitals born from 2016 to 2020. MLP-QM scores ranged from -4.8 to 2.7, with mean 0.04. MLP infants had higher rates of human milk at discharge, lower in-hospital mortality, and less infection after day 3 (Table 1). Within the same hospital, MLP-QM composite scores had weak correlation with Baby-MONITOR scores (Figure 1, r=0.47). There was weak correlation in survival (r=0.19), no pneumothorax (r=0.35), and no infection after 3 days (r=0.45), but strong correlation in human milk at discharge (r=0.79) and no hypothermia (r=0.76) (Figure 2).Conclusion(s): We adapted Baby-MONITOR, an established VLBW quality measure, for the MLP population to create an adapted MLP quality measure, MLP-QM. Weak correlation in Baby-MONITOR scores in extremely/very preterm infants and MLP-QM scores in MLP infants in the same hospital suggests that hospital care practices vary greatly between the two populations. Hospital practices impacting pneumothorax, infection, and survival may vary most significantly. Formal development of a quality measure for MLP infants is needed to assess and optimize MLP care practices.
Elizabeth Salazar CVEGS_CV.12.2021_final.pdf
Figure 1: Correlation of Composite Adapted MLP Quality Measure Scores in MLP Infants with Baby-MONITOR Scores in Extremely and Very Preterm Infants