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Quality Improvement Project to Decrease Delivery Room Intubations in Preterm Infants.

Venkatakrishna Kakkilaya1, Ihab Jubran1, Vaishali Mashruwala1

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Summary
This summary is machine-generated.

A quality improvement project successfully reduced delivery room intubation (DRI) in preterm infants by optimizing face mask positive pressure ventilation (Fm-PPV). This intervention improved infant outcomes, decreasing rates of bronchopulmonary dysplasia (BPD) and other complications.

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Area of Science:

  • Neonatal Resuscitation
  • Quality Improvement in Pediatrics
  • Neonatal Intensive Care

Background:

  • Delivery room intubation (DRI) is associated with increased mortality and morbidity in preterm neonates.
  • Bronchopulmonary dysplasia (BPD) is a significant complication in infants born at ≤29 weeks' gestation.
  • Optimizing non-invasive ventilation strategies is crucial for improving preterm infant outcomes.

Purpose of the Study:

  • To decrease delivery room intubation (DRI) rates in preterm infants (≤29 weeks' gestation).
  • To improve the efficacy of face mask positive pressure ventilation (Fm-PPV) during neonatal resuscitation.
  • To reduce the incidence of death or bronchopulmonary dysplasia (BPD) in this vulnerable population.

Main Methods:

  • A quality improvement project focused on enhancing Fm-PPV techniques.
  • Implementation of a resuscitation bundle including specific mask types, capnography, and adjusted ventilation pressures.
  • Utilized plan-do-study-act cycles and control charts to monitor DRI rates and outcomes pre- and post-intervention.

Main Results:

  • The intervention group showed a significant reduction in DRI rates (58% vs 37%, P < .01).
  • Post-intervention, there was a lower incidence of bronchopulmonary dysplasia (BPD) (26% vs 13%, P < .01) and severe retinopathy of prematurity (14% vs 5%, P = .01).
  • Improved resolution of bradycardia and decreased need for mechanical ventilation were observed post-intervention.

Conclusions:

  • A targeted resuscitation bundle effectively decreased delivery room intubation rates in preterm infants.
  • The implemented quality improvement strategies led to better neonatal outcomes, including reduced BPD.
  • Optimizing Fm-PPV is a viable strategy to improve the care and survival of extremely preterm infants.