{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T05:01:59Z","timestamp":1785214919124,"version":"3.55.0"},"reference-count":19,"publisher":"Georg Thieme Verlag KG","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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).<\/jats:p>\n                  <jats:p>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.<\/jats:p>\n                  <jats:p>Post implementation data (n\u2009=\u2009130) showed a reduction in severe IVH (from 25 to \u223c20%), a 7% reduction in grade 2 and grade 3 BPD, consistently low ROP rates (&lt;3%), and a downward mortality trend in 2023.<\/jats:p>\n                  <jats:p>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.<\/jats:p>","DOI":"10.1055\/a-2792-3626","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T23:43:31Z","timestamp":1770335011000},"page":"1515-1521","source":"Crossref","is-referenced-by-count":0,"title":["From Pathway to Practice: Implementing Evidence-Based Quality Improvement for ELBW Care"],"prefix":"10.1055","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7584-7116","authenticated-orcid":false,"given":"Susan M.","family":"Bedwell","sequence":"additional","affiliation":[{"name":"Oklahoma Children's Hospital, University of Oklahoma College of Nursing, Oklahoma City, Oklahoma, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulana","family":"Pogribna","sequence":"additional","affiliation":[{"name":"Oklahoma Children's Hospital, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1016\/j.pcl.2018.07.011","article-title":"Quality improvement methodologies: Principles and applications in the pediatric emergency department","volume":"65","author":"R Migita","year":"2018","journal-title":"Pediatr Clin North Am"},{"issue":"26","key":"ref2","doi-asserted-by":"crossref","first-page":"2725","DOI":"10.1056\/NEJMoa061115","article-title":"An intervention to decrease catheter-related bloodstream infections in the ICU","volume":"355","author":"P Pronovost","year":"2006","journal-title":"N Engl J Med"},{"issue":"05","key":"ref3","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1056\/NEJMsa0810119","article-title":"A surgical safety checklist to reduce morbidity and mortality in a global population","volume":"360","author":"A B Haynes","year":"2009","journal-title":"N Engl J Med"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1002\/jpen.1726","article-title":"Postoperative feeding guidelines improve outcomes in surgical infants","volume":"44","author":"F Shakeel","year":"2020","journal-title":"JPEN J Parenter Enteral Nutr"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"F422","DOI":"10.1136\/archdischild-2017-313362","article-title":"Care bundles to reduce central line-associated bloodstream infections in the neonatal unit: A systematic review and meta-analysis","volume":"103","author":"V Payne","year":"2018","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"e1007","DOI":"10.1542\/peds.2014-3918","article-title":"Small baby unit improves quality and outcomes in extremely low birth weight infants","volume":"136","author":"M Morris","year":"2015","journal-title":"Pediatrics"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1038\/s41372-021-00984-0","article-title":"Development of a small baby unit to improve outcomes for the extremely premature infant","volume":"42","author":"O Fathi","year":"2022","journal-title":"J Perinatol"},{"issue":"03","key":"ref8","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.mayocp.2017.01.001","article-title":"Clinical practice guidelines: A primer on development and dissemination","volume":"92","author":"M H Murad","year":"2017","journal-title":"Mayo Clin Proc"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.jclinepi.2010.09.011","article-title":"GRADE guidelines: A new series of articles in the Journal of Clinical Epidemiology","volume":"64","author":"G H Guyatt","year":"2011","journal-title":"J Clin Epidemiol"},{"issue":"20","key":"ref10","doi-asserted-by":"crossref","first-page":"2072","DOI":"10.1001\/jama.2014.4950","article-title":"Updating practice guidelines","volume":"311","author":"P G Shekelle","year":"2014","journal-title":"JAMA"},{"issue":"04","key":"ref11","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1097\/JPN.0000000000000695","article-title":"Nurse-driven interventions for improving ELBW neurodevelopmental outcomes","volume":"36","author":"J Gomez","year":"2022","journal-title":"J Perinat Neonatal Nurs"},{"issue":"06","key":"ref12","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1164\/rccm.201812-2348OC","article-title":"The diagnosis of bronchopulmonary dysplasia in very preterm infants. 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