Background Preterm infants are a group in which evidence shows early management can improve outcomes.1 2

Aims To institute a quality improvement programme for immediate intensive care of infants <30 weeks gestation.

Methods (1) Multidisciplinary groups collated evidence base for:

• (a) Resuscitation & transfer to NICU.

• (b) Immediate stabilisation on NICU.

• (c) Respiratory support.

(2) An initial audit examined eligible infants March–April 2008. This suggested areas for improvement. (3) After consultation, new guidelines and standards were agreed. These were launched in July 2009 following a series of training days. A brief-rebrief-debrief cycle was introduced. (4) Audit data is collated prospectively, analysed 2-monthly and disseminated widely.

Results Data for six standards were compared from three epochs:

• (a) Initial audit.

• (b) 6 months pre-introduction (January–June 2009).

• (c) 1 year post introduction (July 2009–June 2010).

Conclusions Results indicate improvement between A and C. Some changes in practice preceded the introduction of the guidelines, reflecting the effect of discussions during the process.

The debrief process has refined the guidelines. Staff feedback suggests enhanced team-working.

Clear guidance and strategies for structured communication can improve newborn care.