Published online November 1, 2006
PEDIATRICS Vol. 118 Supplement November 2006, pp. S159-S168 (doi:10.1542/peds.2006-0913N)
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ARTICLE


Management of High-Order Multiple Births: Application of Lessons Learned Because of Participation in Vermont Oxford Network Collaboratives

Anand D. Kantak, MDa, Jennifer L. Grow, MDa, Judy Ohlinger, RNC, MSNa, Heather J. Adams, RNC, MSNa, Amy M. Knupp, RNC, MSNa and Justin P. Lavin, Jr, MDb

a Division of Neonatology, Department of Pediatrics
b Department of Maternal-Fetal Medicine, Akron Children's Hospital, Akron, Ohio

OBJECTIVES. The delivery and care of sextuplets is complex. Potentially better practices that were developed as part of the Vermont Oxford Network improvement collaboratives were used to prepare for a sextuplet delivery at Akron Children's Hospital.

METHODS. The team used potentially better practices that were learned from the Neonatal Intensive Care Quality Improvement Collaborative 2002 using multidisciplinary teams. There was extensive media coverage of the delivery.

RESULTS. The goal was to use nearly all potentially better practices that focused on the goals of reducing nosocomial infection, reducing chronic lung disease, reducing radiograph use, reducing length of stay, reducing blood gas use, promoting nutrition, reducing intraventricular hemorrhage, and enriching family-centered care. The center aimed to use these 97 potentially better practices. Of the 97 possible potential better practices as set by the Neonatal Intensive Care Quality Improvement Collaborative 2002, 96 (99%) were used.

CONCLUSIONS. This is a blueprint that any center that is faced with high-order multiple births could use as a reference point to begin planning. The team created a benchmark to achieve in every birth of very low birth weight infants and not just a special situation of high-order multiple births.

Key Words: high-order multiple births • sextuplets • quality improvement

Abbreviations: VON—Vermont Oxford Network • NIC/Q—Neonatal Intensive Care Quality Improvement Collaborative • PBP—potentially better practice • GA—gestational age • NNP—neonatal nurse practitioner • LOS—length of stay • CPAP—continuous positive airway pressure • PDA—patent ductus arteriosus • PICC—peripherally inserted central catheter • HFOV—high-frequency oscillatory ventilation • IMV—intermittent mechanical ventilation

Accepted Jul 18, 2006.


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