Each NICU QI team will receive standardized QI education using the 6-hour EPIQ Workshop which involves hands-on approach to enable teams to successfully implement QI projects together. EPIQ 10 Steps and QI Tools will be used to build the team's understanding of QI using realistic improvement opportunities based on the standardized care bundles identified in the trial.

A care bundle is a small, simple set (3-5 elements) of evidence-based practices that, when performed collectively and reliably, will result in improved patient outcomes. This bundle will aim to implement best practices for stabilization and respiratory care in moderate and late preterm infants (MLPIs) including

1. establishing effective ventilation in the delivery room
2. prevention of hypothermia
3. early diagnosis and management of respiratory distress with continuous positive airway pressure (CPAP)
4. standardized approach for surfactant indications and administration
5. standardized approach for early extubation.

A care bundle is a small, simple set (3-5 elements) of evidence-based practices that, when performed collectively and reliably, will result in improved patient outcomes. This bundle will aim to implement best practices for nutritional support in MLPIs including

1. early initiation of enteral or parenteral nutrition;
2. standardized tables for feeding initiation and progression
3. optimizing breastfeeding and use of mother's own milk
4. standardized approach for a transition from enteral nutrition via tube feeds to oral feeds.

Each NICU in the intervention arm will have one or more assigned members of the study team who are experienced in collaborative QI and EPIQ methods. The mentors will help local QI teams to engage frontline staff in QI and navigate the unit-specific challenges.

The study team will conduct virtual meetings every 2 months for the NICUs in intervention arm allowing local QI teams to discuss progress, and share data. The investigators will arrange annual in-person or virtual meetings for the NICUs in the intervention arm to present projects, successes, and lessons learned. These NICUs will have continuing access to the data and will receive quarterly reports using statistical process control charts outlining the unit's performance compared to other units and to the group average.

All participating NICUs will be in the control arm during the first year prior to randomization to create a baseline of the current practices and between-units variation. NICUs in the control arm can continue conducting QI activities relevant to current practice, but without receiving the interventions outlined above until they transition to the intervention arm. The investigators will capture these activities and account for them in the analysis.

Axillary temperature <36.5°C.

Blood glucose <2.6 mmol/L.

Date and method of administration

Total number of days administered

Date when the enteral intake reaches 120 ml/kg/day.

Difference in days between birth date and date when the infants regains or exceeds birth weight after initial weight loss.

actual values in grams

actual values in centimeters

actual values in centimeters

Defined as number of feeds where infant received breastfeeding or maternal expressed breastmilk

Unplanned readmission to any hospital in Alberta following discharge

Emergency room visits to any hospital in Alberta following discharge

Proportion of infants who dies before first discharge home

Corrected age = chronological age - days required for an infant to complete postmenstrual age of 40 weeks.

Proportion of infants who require escalation of care and transfer to Level III NICU.

Semi-structured interviews with selected sample of staff from each NICU