The document outlines several evidence-based practices implemented in a NICU to prevent various conditions in preterm infants. These include a ventilator-associated pneumonia prevention bundle, strategies to prevent necrotizing enterocolitis like early enteral feeding and probiotic use, practices to prevent anemia like delayed cord clamping and restricted blood sampling, metabolic bone disease prevention with early nutrition and supplements, and efforts to increase breast milk availability like educating parents and providing breast pumps.

1. NABH
EVIDENCE BASED PRACTICES IN OUR NICU

2. VAP Prevention bundle
• Improving knowledge of care giver/privileging (1a)
• Adherence to strict hand hygiene (1a)
• Changing the ventilator circuit only when visibly contaminated (1a),
• Draining condensation from the ventilator circuit every 2–4 hours (1b)
• Avoiding repeated intubations (2)
• Give oral suction before adjusting ET tube
• Antibiotic stewardship
• Performing mouth care routinely??/Oral colostrum painting
• Head end elevation ??
• Avoiding the use of mechanical ventilation
• Daily assessment of readiness to extubate

3. PREVENTION OF NEC
• Early enteral feeding –MOM /PDHM
• Standard feeding regimen
• Strict adherence to Antibiotic policy/antibiotic stewardship
• Prophyllactic use of probiotics for prevention of NEC not
recommended for babies < 1000gm (AAP 2021)

4. Prevention of anemia in extreme preterms
• Delayed cord clamping beyond 30 secs if baby is not floppy
• Microsampling techiques, point of care blood gas analyzer
• Restricting arterial lines
• Stringent blood sampling policy-labs are ordered only after discussion
in the unit for each baby

5. Prevention of Metabolic bone disease
• Early enteral nutrition
• Early IV Phosphorous supplementation-Potphos added to PN after 48
hours, IV Calcium is stopped by 48 hrs
• Early HMF-HMF is added one enteral feeds is 60 ml/kg/day
• Optimising Ca, P, Vitamin D doses based on labs

6. Practices to increase breast milk availability
for preterms
• Informing the importance of expressed breast milk during antenatal
counselling
• Prescription for breast pump to family during first postnatal
counselling as early as possible after birth
• Early breast milk expression , as early as possible
• Early Parent participation/KMC/NNS
• Training sessions by NICU staff on breast milk expression and storage
• Tab Domperidone for mother after 1 week, if milk secretion is less