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Am J Perinatol
DOI: 10.1055/a-2792-3626
Original Article

From Pathway to Practice: Implementing Evidence-Based Quality Improvement for ELBW Care

Authors

  • Susan M. Bedwell    ‡

    1   Oklahoma Children's Hospital, University of Oklahoma College of Nursing, Oklahoma City, Oklahoma, United States

  • Ulana Pogribna   ‡

    2   Oklahoma Children's Hospital, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, United States
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Abstract

Objective

Structured clinical guidelines improve outcomes in neonatal care. At Oklahoma Children's Hospital, the need for a standardized approach to extremely low birth weight (ELBW) infants became urgent due to rising acuity and care variability. Despite existing nursing protocols, the unit lacked comprehensive interdisciplinary guidelines for ELBW infants. Key goals included reducing intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP).

Study Design

Multidisciplinary teams developed eight clinical pathways using evidence-based models. The Appreciative Inquiry framework was used to engage staff and build consensus. The interdisciplinary workgroups conducted literature reviews, developed system-based protocols, and facilitated iterative revisions. Pathways were implemented and were supported by education, exposure, and saturation strategies. Key metrics were benchmarked using Vermont Oxford Network (VON) data, with IVH, BPD, and ROP as outcome measures and mortality as a balancing measure. Real-time data collection was used to drive further improvement. PDSA (plan, do, study, act) cycles targeted thermoregulation, line placement, early surfactant administration, and glucose and oxygen management.

Results

Post implementation data (n = 130) showed a reduction in severe IVH (from 25 to ∼20%), a 7% reduction in grade 2 and grade 3 BPD, consistently low ROP rates (<3%), and a downward mortality trend in 2023.

Conclusion

ELBW pathways improved care standardization and outcomes without increasing mortality. Continued efforts beyond the first week of life are needed to sustain and expand improvements.

Key Points

  • Multidisciplinary pathways improved standardization and care for ELBW infants.

  • Pathways led to modest gains in BPD and IVH, guiding future quality improvement priorities.

  • Education and teamwork drove adoption and sustainability without major resource needs.

Keywords

extremely low birth weight - interdisciplinary - clinical pathways - evidence-based - quality improvement

Data Availability Statement

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at the OU Health, Oklahoma City, Oklahoma, United States.


Contributors' Statement

S.M.B.: Conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, validation, visualization, writing–original draft, writing–review and editing. U.P.: Conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, validation, visualization, writing–original draft, writing–review and editing.


‡ These authors contributed equally to this article.


Supplementary Material



Publication History

Received: 25 July 2025

Accepted: 19 January 2026

Article published online:
05 February 2026

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