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Background The Children’s Mercy Fetal Health Center (FHC) was created to be able to deliver infants with complex fetal diagnoses including congenital heart disease. Mothers are referred from all over the Midwest region for their babies to have access to specialized care immediately after birth. Nearly all babies born in the FHC are admitted to our neonatal intensive care unit (NICU), as there are not well-established guidelines for keeping babies with their mothers if they have low-risk congenital heart disease that do not need intensive care continuous monitoring. Maternal infant bonding starts before an infant is born and becomes stronger in those first few moments after birth. Maternal infant bonding is important to help establish breastfeeding if desired and for early childhood development. Previously, only 27% of the patients with these diagnoses that would have been safe to room in with their mothers did. We aim to increase the rate of neonates born with low acuity congenital heart disease that room-in with their mothers in the FHC from 27% to 47% by October 2023. Methods We targeted infants with prenatal diagnoses of likely asymptomatic vascular rings, balanced AV canal, low risk intermittent fetal supraventricular tachycardia, tetralogy of Fallot without concern for pulmonary obstruction or low risk coarctation of the aorta. The first PDSA cycle implemented a protocol that was developed in collaboration with Pediatric Cardiologists to help providers assess the appropriateness of allowing a patient to room in with the mother with intermittent monitoring of vital signs. This protocol also dictates how frequently vital signs should be assessed by nursing once a baby is rooming-in with its mother. Education was provided to the physicians, NNPs and nurses about implementing the protocol. The second PDSA cycle included Fetal Cardiology APRNs discussing the appropriateness of patients rooming in with their mothers at weekly Fetal Health Center meetings. The quantitative data is collected monthly based upon FHC weekly patient e-mails and review of the medical records. Results The rate of infants rooming-in increased to 38% following implementation of the first PDSA cycle and up to 52% following implementation of the second PDSA cycle. Discussion We were able to increase the number of infants with low acuity congenital heart disease that roomed-in with their mothers in the FHC without any rapid responses. The next step is to survey families to better understand their experience of having their infant room-in with them in the FHC.




Presented at the 2023 Children's Hospital Neonatal Consortium Annual Symposium; Denver, CO; Oct 11-13, 2023 and at the American Academy of Pediatric 2023 National Conference; Washington, D.C.; Oct 20-24, 2023.

Increasing the Rate of Infants Rooming In with their Mothers with Low Acuity Congenital Heart Disease

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