Early Extended Neonatal Screening for Congenital Cytomegalovirus Infection: A Quality Improvement Initiative.

BACKGROUND: Identification of congenital cytomegalovirus (cCMV) infection in neonates is important for early diagnosis of sensorineural hearing loss. Therefore, a quality improvement project was designed with an aim to improve newborn CMV screening by 25% from a baseline rate of 22%. METHODS: This project was conducted across two hospital sites at one medical center with two tertiary care newborn nurseries and neonatal intensive care units. Symptomatic neonates with suggestive findings of cCMV, who had failed the newborn hearing screen, who had not had a hearing screen performed by 10 days of age, or who were infants of HIV-positive mothers were screened for cCMV. Serial interventions (formalized teaching sessions using an algorithm and involving a nurse educator, creation of electronic medical record order sets, huddle board reminders, and regular audits) were conducted, and statistical process control p-charts were used to identify any signals and to determine if there was any special cause variation. RESULTS: Of 5,817 infants born in 2018, 903 were eligible for screening. Small for gestational age (46%) was the most common indication for screening. After multiple interventions, the median screening rate increased from a baseline of 22% in 2016 to 74% during the one-year study period. Four infants had positive CMV screen and received appropriate treatment as a result of these interventions. CONCLUSION: Multidisciplinary quality improvement initiatives can improve newborn screening for cCMV infection in a tertiary care environment.

Achieving Baby-Friendly Designation at a Large Metropolitan Center.

OBJECTIVE: This study aimed to describe the journey of obtaining Baby-Friendly designation as a large metropolitan center in an urban city and review the initial patient-related outcomes. STUDY DESIGN: Our medical center participated in the New York City Department of Health and Mental Hygiene Breastfeeding Hospital Collaborative from 2012 to 2017. Monthly meetings were held to monitor data, and audits conducted among prenatal sites and maternity units. This hospital collaborative was established to help facilities through the designation process. RESULTS: Breastfeeding education in the prenatal setting was provided consistently at all outpatient sites. By 2017, 89.8% of patients had received appropriate education and support during their prenatal visits. There was a shift in feeding pattern from mostly formula feeding with some breastfeeding to primarily breastfeeding with fewer formula feeds. Baby-Friendly designation was achieved in June 2017 after a formal Baby-Friendly USA assessment. CONCLUSION: Since embarking on this journey, there has been a consistent increase in antenatal patient education and a paradigm shift from some breastfeeding to mostly breastfeeding among the mother-baby dyads which combination feed. Our hospital center has continued to successfully maintain the workflow changes implemented during the Baby-Friendly process.