Background Our hospital attends 90 VLBW and 40 ELBW infants/year. Vermont Oxford Network is used as benchmarking tool.

Aims To improve quality of care delivered to ELBW´s during the first week of life. Primary outcome is IVH reduction. Secondary outcomes are mortality, late onset sepsis (LOS) and ROP reduction.

Methods An interdisciplinary group leaded by 4 nurses and 3 neonatologists was created in January 2012. Management of ELBW infants was reviewed to identify weaknesses and strengths. The original team was then divided into subgroups that worked together for problem resolution. 2 gynaecologists, 1 surgeon and 60 members of the neonatal unit were involved (70% of nurses and 90% of neonatologists). Specific actions were developed for 1. Delivery Room: plastic wrapping, delayed chord clamping and blood sampling; 2. Admission and first golden hours: temperature and humidity targets, blood sampling, calostrum administration, enemas and positional care. Results were transmitted in oral sessions and written guidelines to the rest of the Unit.

Results No changes were found in 2012 compared to the last five years. However in 2013, a decrease was seen in inborns in severe IVH (from 11,6 to 10,9%), LOS (15,8% to 9,8%) and severe ROP (10,1 to 5,9%).

Conclusions A high percentage of the neonatal unit has been involved in this project. Short term outcomes have improved for the first time last year. A qualitative change difficult to quantify has also been produced. Caution must be taken when interpreting numerical results as they reflect improvement of only one year.