Association of individual and bundled evidence-based practices with adverse outcomes in very preterm infants: a multicenter retrospective study

Background Although evidence-based practices (EBPs) can improve outcomes in very preterm infants (VPIs), real-world implementation rates and evidence regarding their synergistic effects remain limited. This study, which is based on the Shenzhen Neonatal Data Network (SNDN), evaluated the current implementation status of EBPs and the impact of their synergistic effects on clinical outcomes. Methods We conducted a retrospective study on 536 VPIs with a gestational age <32 weeks in 2024. These infants were categorized into a survival without major morbidity group and an adverse outcome group (severe complications/death), with differences in the implementation of EBPs evaluated between the two groups. Using the “all-or-none” approach, we further assessed four core EBPs: complete course of antenatal corticosteroids (ACS); antenatal magnesium sulfate (MgSO₄); maintenance of normothermia (36.5 °C–37.5 °C) within one hour after birth; and caffeine therapy. Multivariate logistic regression analysis was employed to explore the associations between EBP implementation and adverse outcomes. Results Bundle implementation of four EBPs significantly reduced adverse outcomes in VPIs (aOR=0.44, 95% CI: 0.23–0.83). Independent protective factors included delivery at tertiary perinatal centers with RDS management capabilities (aOR=0.18, 95% CI: 0.04–0.86); and normothermia within the first hour after birth (aOR=0.58, 95% CI: 0.37–0.91). Gestational age stratified analysis revealed that the protective effect of the four EBPs bundle was most pronounced in infants <28 weeks (aOR=0.22, 95% CI: 0.06–0.78).Only 19.4% of VPIs received all four EBPs. Conclusions Bundled implementation of EBPs significantly improves clinical outcomes in VPIs. However, suboptimal adherence—particularly for normothermia within the first hour after birth—necessitates targeted quality improvement initiatives. We can enhance quality and improve survival without major morbidity in VPIs by systematically improving the implementation rates of EBPs.