Impact of Evidence-Based Practice Bundles on Clinical 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 asurvival without major morbidity (SWMM) group and an adverse outcome group (severe complications/death), with differences in the implementation of evidence-based practices (EBPs) evaluated between the two groups. Using the "all-or-none" approach, we further assessed five core EBPs: delivery at an experienced perinatal center; 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 associationsbetween EBP implementation and adverse outcomes. Results Bundle implementation of five EBPs significantly reduced adverse outcomes in VPIs (aOR=0.47, 95% CI: 0.25–0.90). Independent protective factors included delivery at RDS-experienced centers (aOR=0.18, 95% CI: 0.04–0.86); delayed cord clamping (DCC)/umbilical cord milking (UCM) (aOR=0.55, 95% CI: 0.31–0.96);and normothermia within the first hour after birth (aOR=0.58, 95% CI: 0.37–0.91). Only 19.2% of VPIs received all five EBPs. The lowestimplementation rates were reported for normothermia within the first hour after birth (49.4%) and DCC/UCM (23.3%). Conclusions Bundled implementation of EBPs significantly improves clinical outcomes in VPIs. However, suboptimal adherence—particularly for normothermia within the first hour after birth and DCC/UCM—necessitates targeted quality improvement initiatives. We can enhance quality and improve SWMM in VPIs by systematically improving the implementation rates of EBPs.