Advocacy in Neonatology

Advocating for Preterm Infants

Advocating for equality for preterm infants is complex, difficult, soul searching, must not be discriminatory, and requires a highly trained, compassionate, and caring professional team working in tandem with the family. At the borders of viability, currently designated the periviable period,[1] [2] there is considerable uncertainty regarding the risks to mother and infant regarding mortality and morbidity. Although there is abundant data concerning neonatal morbidity and mortality, the evidence is valid for a group, but unreliable for a given individual. Of concern in evaluating the available outcome data is that it is mainly reported by gestational age and this number is so imprecise.[3] Even with early ultrasound evaluation the margin of error exceeds a whole week which at gestational ages between 22 and 25 weeks is huge and complicates the team's decision regarding active intervention. Furthermore, there is considerable difference in outcomes between 24 weeks and 3 days and 24 weeks and 6 days. Both groups being considered –24 weeks.

Neonatal intensive care units (NICUs) aim to provide safe, high-quality medical and surgical care for all newborns. The creation of, and widespread participation in, NICU quality collaboratives has no doubt accelerated progress in the field of neonatal quality improvement and safety. However, there still remains limited evidence of overall efficacy of these collaboratives. NICUs strive to apply the best possible evidence in their local setting, known as “potentially better practices,” to achieve improved patient outcomes. However, similar interventions applied in a similar fashion in similar NICUs often do not produce the same results. This unexplained variability in outcomes between NICUs begs the question: What is the secret sauce? Why do some NICUs consistently outshine others in spite of the application of the same “potentially best practices”? To answer these questions, it becomes necessary to determine those factors that contribute to success or failure of improvement programs, including less tangible aspects such as NICU culture/environment, leadership, teamwork, and organizational structure. Only when these questions are satisfactorily answered can we anticipate more consistent short- and long-term outcomes. Evaluating specific care practices may illuminate key factors.

• References

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