P0067 - Building Babies’ Brains: A Quality Improvement (QI) Collaborative to Inform Interventions that Increase Infant Holding in the Neonatal Intensive Care Unit (NICU) and Improve Neurodevelopmental Outcomes

Introduction: Holding infants in the NICU improves neurodevelopmental outcomes and increases maternal-infant bonding. However, the most effective interventions to increase the frequency of holding for neonates with pulmonary hypoplasia (PH) are unclear. The purpose of this project is to investigate barriers to holding in the NICU and obtain provider perspectives to inform interventions that will increase infant holding and ultimately improve neurodevelopmental outcomes.

Methods: This single-institution QI project utilized surveys to investigate barriers to holding infants with pulmonary hypoplasia in the NICU. A patient-specific survey was administered in a two-week period to determine baseline rates of holding. Information on respiratory support was obtained from medical records. Bedside nurses provided information about whether or not a patient was held, by whom, and for how long. Nurses and respiratory therapists (RTs) completed a provider survey. Respondents identified potential barriers on a checklist and completed seven-point Likert scale questions about the importance of infant holding and their own comfortability.

Results: The patient-specific survey was completed for 14 patients with PH, including 11 with congenital diaphragmatic hernias and three with Giant Omphaloceles. 123 surveys were completed over the 10-day period. Patients were held on 79 (64.2%) survey days, and parents visited on 84 (68.3%) survey days. There was a correlational trend between the number of days each patient was held and the number of days parents visited, as seen in figure 1. As the level of respiratory intervention decreased, the percent of days patients were held increased, as seen in figure 2. The provider survey was completed by 79 nurses and 30 RTs. For questions on importance of holding, nurses rated 5.95 and RTs rated 5.96, on average. For questions on feasibility of increasing holding, nurses rated 6.06 and RTs rated 5.82. For comfortability facilitating parental holding, there was a statistically significant increase in ratings based on 0-1, 1-2, 3-5, or over 6 years of experience in a NICU, with ratings of 5.52, 5.77, 6.27, and 6.46 respectively (p=0.0019). For the frequency of holding discussions on rounds, nurses rated 2.97 and RTs rated 2.67. For the barrier checklist, the highest percent of endorsements from nurses were high frequency ventilation (97%), chest tube (65%), and parent availability (56%). RTs identified high frequency ventilation (83%), history of desaturation events (50%), and communication from nursing (47%) most frequently.

Conclusions: High ratings among providers on the importance and feasibility of increasing holding suggests that our institution’s NICU would be receptive to evidence-based holding interventions. A parent survey may further illuminate effective interventions to increase parental knowledge and infant holding. The data show that additional education on holding with guidelines related to respiratory support may increase nurses’ comfortability facilitating parent holding more rapidly and may increase frequency as well.