title: Effects of delivery room quality improvement on premature infant outcomes.
abstract: Delivery room management interventions have been successfully implemented via collaborative quality improvement (QI) projects. However, it is unknown whether these successes translate to reductions in neonatal morbidity and mortality.
  
  
  
  This was a prospective pre-post intervention study of three nonrandomized hospital groups within the California Perinatal Quality Care Collaborative. A collaborative QI model (Collaborative QI) was compared with a single-site QI model (NICU QI) and a non-participant population when implementing evidence-based delivery room practices. The intervention period was between June 2011 and May 2012. Infants born with gestational age between 22 weeks 0 days and 29 weeks 6 days and birth weight ⩽1500 g were included. Outcomes were mortality and select morbidities (bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP) and necrotizing enterocolitis (NEC)). Outcomes were compared between the baseline (January 2010 to May 2011) and post-intervention period (June 2012 to May 2013) within each comparison group.
  
  
  
  Ninety-five hospitals were included with 4222 infants in the baseline period and 4186 infants in the post-intervention period. The Collaborative QI group had significantly reduced odds of developing BPD post-intervention (odds ratio (OR) 0.8, 95% confidence interval (CI) 0.65 to 0.99) or composite BPD-death (OR 0.83, 95% CI 0.69 to 1.00). In both the Collaborative QI and non-participants there were also reductions in IVH, severe IVH, composite severe IVH-death, severe ROP and composite severe ROP-death.
  
  
  
  Hospitals dedicated to improving delivery room practices can impact neonatal outcomes.
authors.affiliation: Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA.|California Perinatal Quality Care Collaborative, Palo Alto, CA, USA.
authors.forename: W
authors.initials: W
authors.lastname: Lapcharoensap
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.|California Perinatal Quality Care Collaborative, Palo Alto, CA, USA.
authors.forename: M V
authors.initials: MV
authors.lastname: Bennett
authors.affiliation: Pediatrix Medical Group, San Jose, CA, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Powers
authors.affiliation: University of California San Diego, San Diego, CA, USA.
authors.forename: N N
authors.initials: NN
authors.lastname: Finer
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.|Center for Advanced Pediatric and Perinatal Education, Lucile Packard Children's Hospital, Palo Alto, CA, USA.
authors.forename: L P
authors.initials: LP
authors.lastname: Halamek
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.|California Perinatal Quality Care Collaborative, Palo Alto, CA, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Gould
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.|Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, Palo Alto, CA, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Sharek
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.|California Perinatal Quality Care Collaborative, Palo Alto, CA, USA.
authors.forename: H C
authors.initials: HC
authors.lastname: Lee
mesh_terms: D001724:Birth Weight; D001997:Bronchopulmonary Dysplasia / Q000401:mortality; D002140:California / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000401:mortality; D003696:Delivery Rooms / Q000458:organization & administration*; D020345:Enterocolitis, Necrotizing / Q000401:mortality; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D015999:Multivariate Analysis; D011247:Pregnancy; D011446:Prospective Studies; D058996:Quality Improvement; D012044:Regression Analysis; D012178:Retinopathy of Prematurity / Q000401:mortality