Vermont Oxford Network (VON)

Quality Improvement & Education:NICQ 2021-22 continues the series of intensive improvement collaboratives sponsored by Vermont Oxford Network. Interdisciplinary teams from 42 institutions in North America are working together to improve the quality and safety of medical care for newborn infants and their families by applying the concepts of family-integrated care, teams and teamwork, the sequence to achieve change, increased value, and standardization into their collaborative improvement work, addressing: Optimizing Outcomes of the Micro-Premature Infant; Optimizing Nutrition and Reducing Necrotizing Enterocolitis; and Multi-system: Minimizing Brain Injury and Minimizing Lung Injury. This project commenced in January 2021 and continued through December 2022.iNICQ webinar series: iNICQ 2022 - The Ins & Outs of Neonatal Care: Improving Critical Transitions for Every Newborn - Our Internet-based Newborn Improvement Collaborative for Quality (iNICQ) is a multi-center collaborative dedicated to improving neonatal transitions in all phases of care - from birth to home. A critical transition is any change of the care site or care team, or any significant change to an infant's status or plan of care. These many important transitions occur within a hospital or health system and between several hospitals and communities, and all levels of hospitals, health systems, or regional groups benefit from improving these vulnerable times of care. 77 multi-disciplinary teams used VON's structured curriculum and expert faculty to improve critical transitions. Additionally, teams had access to participate in the Experience-Based Co-Design (EBCD) curriculum with additional faculty, including those from the Point of Care Foundation.Annual Quality Congress- The 2022 Vermont Oxford Network Annual Quality Congress was held in person in Chicago, IL between Sept 8-11, 2022. The Vermont Oxford Network Annual Quality Congress gathered our worldwide community dedicated to improving the quality, safety, and value of care for newborn infants and families. Participants included newborn care providers of all disciplines and families who shared their experiences as equal members of the improvement team. The multi-day event featured faculty at the leading edge of technology, world leaders in neonatology, and experts in improvement science. Teams gathered to share improvement stories and generate new ideas to implement at their center. The 2022 Annual Quality Congress convened hundreds of healthcare professionals and families to learn about and discuss new data, new science, and new approaches in newborn care.

DATABASE/MEMBERSHIP SERVICES:Membership: In 2022 there were 1171 active members in the Database. Membership in the Network for the Very Low Birth Weight Database (up to 1500 grams) cost $5550 in 2022. The 2022 fee for the Expanded Database (all NICU admissions) membership was based on hospital size (AHA Data). Small hospitals were $6050 per year, medium hospitals were $7500 per year and large or Children's hospitals were $8950 per year. Membership entitled members to yearly reports from the database, access to the Internet reporting system and participation in clinical trials.Scientific studies of the quality of care carried out in intensive care nurseries included preparation of reports on results. In 2023 we published the Vermont Oxford Network Annual Database Summary for 2022, a detailed compendium describing the practices and outcomes at 1088 neonatal units caring for very low birth weight infants and the Vermont Oxford Network 2022 Expanded Database Summary describing the practices and outcomes of all NICU infants regardless of birth weight at 546 units participating in the expanded database. The Nightingale Internet reporting system was provided to members. It allows confidential password protected access to hospital specific reports and Network comparison data.

TRIALS:ELBW Follow-up: 18-24 Month "follow-up" continues for infants born between 401 and 1000 grams or 22 weeks 0 days to 27 weeks 6 days. 45 enters participated in 2022 for the 2019 birth year cohort. Centers received reports of their data by birth year as well as a network cohort report. The New England Follow-Up Network also received their own group report. VON Days: In 2022, there were twelve VON Day Audits on the Ins and Outs of Neonatal Care (aka Critical Transitions). Seventy-three Centers participated in VON Days audits each unit was evaluated and 1,136 infant transitions were evaluated. Additionally, one VON Day Audit on Neonatal Abstinence Syndrome was held. One state participated, with a total of 20 centers participating and 11 infants evaluated. For each of the VON Day Audits, participating centers received reports of their audits.COCHRANE NEONATAL REVIEW - VON continued to sponsor the Cochrane Neonatal Group. Cochrane Neonatal is one of over 50 collaborative review groups of Cochrane. Cochrane is an international not-for-profit and independent organization, dedicated to making up-to-date, accurate information about the effects of healthcare readily available worldwide. As a member of Cochrane, Cochrane Neonatal prepares and disseminates evidence-based, regularly updated systematic reviews of the effects of therapies in neonatal-perinatal medicine. The Cochrane Neonatal Group published nine reviews in 2022.

GLOBAL NEONATOLOGY:GLOBAL HEALTH INITIATIVE VON develops partnerships and supports health professionals around the world with training and research that addresses the specific needs and constraints of resource-limited settings. In 2020, we adapted our volunteer program during the COVID pandemic to support Master's degree Advance Practice Neonatal Nurses at Addis Ababa University through video conferences and tele-mentoring. We continued to build upon our strong foundation of the VON global neonatal database, utilized nationally in Ethiopia in forming the Ethiopian Neonatal Network to inform important research questions and identify quality gaps that must be addressed to improve neonatal care and mortality. In 2022, we received funding from the Bill and Melinda Gates Foundation to use this platform to form the foundation of our partnership with the African Neonatal Association in forming the African Neonatal Network, now including five African countries. We concluded our project funded by the Bill and Melinda Gates Foundation which focuses on the use of tele-mentoring to optimize the use of Continuous Positive Airway Pressure (CPAP) for neonates with Respiratory Distress Syndrome in the Ethiopian Neonatal Network. We continued to collaborate and promote the professional development of colleagues in low- and middle-income countries through research projects and collaborative contributions to the scientific literature.