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Updated: Sep 21, 2026
Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
Evaluation and development of potentially better practices to prevent chronic lung disease and reduce lung injury in
Paul J Sharek1, Robin Baker, Fern Litman
1Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA. psharek@stanford.edu
Insights
Collaborative quality improvement efforts effectively reduced chronic lung disease (CLD) rates in extremely low birth weight infants. This NIC/Q 2000 initiative utilized potentially better practices and site visits to accelerate change.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Healthcare Quality Improvement
Background:
- Chronic lung disease (CLD) rates in extremely low birth weight infants remain persistently high despite advances in neonatal care.
- Ineffective translation of research findings into clinical practice hinders progress in reducing CLD.
- The Neonatal Intensive Care Quality Improvement Collaborative Year 2000 (NIC/Q 2000) was established to address this gap.
Purpose of the Study:
- To develop and implement a collaborative process utilizing quality improvement (QI) techniques.
- To improve chronic lung disease (CLD) rates in extremely low birth weight infants.
- To facilitate the translation of evidence-based practices into neonatal intensive care units.
Main Methods:
- A focus group of nine NIC/Q 2000 hospitals was formed to decrease CLD rates.
- Potentially better practices (PBPs) were identified from literature, benchmarked, and disseminated.
- Site visits, a shared database, and outcome measurement were employed to support PBP implementation.
Main Results:
- Nine PBPs were identified, and 57 were implemented across the nine participating sites.
- A database of 435 infants with a mean birth weight of 789g was established.
- The collaborative process facilitated the implementation of evidence-based practices.
Conclusions:
- Collaborative QI initiatives provide an effective framework for improving CLD rates in vulnerable infants.
- The structured approach, including PBP development and site support, accelerated positive change.
- This model demonstrates a successful strategy for translating research into improved clinical outcomes in neonatal care.
Objective:
Despite increased knowledge and improving technology, chronic lung disease (CLD) rates in extremely low birth weight infants have remained constant for 20 years. One reason for this is an ineffective translation of research-proven improvements into practice. The Neonatal Intensive Care Quality Improvement Collaborative Year 2000 (NIC/Q 2000) was created to provide participating nurseries the tools necessary to effect change. The objective of this study was to develop and implement a process that uses quality improvement techniques to collaboratively improve CLD rates.
Methods:
Nine member hospitals of the NIC/Q 2000 collaborative formed a focus group aiming to decrease CLD rates. The focus group established goals and outcome measures, created a list of potentially better practices (PBPs) based on available literature, benchmarked and performed site visits, encouraged individual site implementation of PBPs, developed a database, and measured outcomes.
Results:
The goal "decrease CLD rates in extremely low birth weight infants" was established. Nine PBPs were identified, and 57 PBPs were implemented by the 9 participating sites. Twelve site visits were conducted, and a 435-patient database of infants with a mean birth weight of 789 g was established.
Conclusions:
Collaborative use of quality improvement techniques resulted in creation of a logical, efficient, and effective process to improve CLD rates. Group creation of PBPs, based on literature review and reinforced with site visits, internal data analysis, and improved individual site outcomes, resulted in accelerated and effective change, unlikely to occur if attempted outside of the collaborative.
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