PC.44 Improved cognitive ability in preterm infants: The impact of a sepsis reduction care bundle

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Abstract

Background

Very low birth weight infants (VLBW; <1500 g) with late onset sepsis have an increased risk of neurodisability. Care bundles to reduce blood stream infections in NICU have been shown to be effective.

Objective

To determine if the implementation of a sepsis reduction care bundle was associated with improvement in neurodevelopmental outcomes in VLBW infants.

Methods

A sepsis improvement care bundle was implemented in a tertiary level NICU between 2006–2007. Mortality and neurological morbidity rates were compared for the pre-intervention (January 2001–December 2007) and post-intervention (July 2008–December 2012) periods. The highest risk VLBW infants (<30 weeks’ gestation) had routine neurodevelopmental assessments at 24 months using the Bayley Scales of Infant development (BSID). Moderate cognitive disability was defined as a cognitive/language score below 2SDs.

Results

Coagulase Negative Staphylococcus septicaemia rates were 7/1000 care days before implementation of the care bundle and have reduced to an average of 2.8/1000 care days by 2013. In the cohort of VLBW infants there was no significant reduction in mortality rates (66/426(16%) vs. 40/310(13%); p = 0.3). A significant reduction in moderate cognitive disability (16/86(19%) vs. 2/44(5%); p = 0.03) was found after full implementation of the sepsis care bundle. Potentially confounding variables (birth weight and gender) were not different (p > 0.05) in the pre and post intervention cohorts.

Conclusions

This is the first description of the long term impact of a sepsis improvement care bundle on neurodevelopmental outcomes in VLBW infants. The improvement seen in cognitive function at 2 years is likely to translate into significantly less long term learning disability.

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