Improving Outcomes of Very Low Birth Weight Babies


The Very Low Birth Weight Program of NUH is a unique and essential initiative that provides specialized and comprehensive care to premature newborns with birth weights below 1500 grams. These vulnerable babies require extensive and costly care due to their prolonged stay in the Neonatal Intensive Care Unit (NICU) and are at high risk for various morbidities, including sepsis, intraventricular haemorrhage (IVH), retinopathy of prematurity (ROP), chronic lung disease (CLD), and necrotizing enterocolitis (NEC).

According to statistics, premature birth accounts for 1 in 10 births globally. In Singapore, incidence of VLBW is approximately 1.5% of all births, around 450 to 600 babies are born with very low birth weight every year. These babies are at high risk for developing a range of health problems, and the Very Low Birth Weight Baby program is crucial in providing care for this group of patients.

The value-based care program for VLBW babies was established since 2017, by leveraging data and innovative techniques by members of the care team to improve existing care for VLBW babies, and has achieved significant success in improving outcomes for VLBW babies since. For example, the program has reduced the incidence of late-onset sepsis, a potentially life-threatening infection that can occur in premature infants from average of 15% annually to below 6% in the last 6 years.  This initiative has also decreased the rate of emergency readmission after hospital discharge. Additionally, the program has greatly reduced the number of routine blood tests (blood gas and blood sugars) which can be painful and cause additional stress for infants.

One of the unique aspects of the Program is its focus on value. By using international standards and best practices to monitor quality measures and ensure cost transparency throughout the hospital care duration, the program has improved on a number of quality measures and maintained a relatively stable cost.

The program also places a strong emphasis on family-centred care, recognizing that parents play a critical role in the care of their premature infants. This approach involves regular communication between the medical team and parents, as well as providing resources and support to help parents become more involved in the care of their premature infants. Knowledge transfer from the care team to parents/care-givers are carefully planned and conducted.

In summary, the Very Low Birth Weight Program is a unique and essential initiative that provides specialized and comprehensive care to some of the most vulnerable babies in the world. By focusing on international standards, best practices, quality outcomes, and family-centred care, the program is helping to improve the outcomes for these fragile patients, reduce unnecessary investigations, and maintain a relatively stable cost.