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Improved Outcomes With Standardized Convalescent Preterm Respiratory Care Practices

Michelle D Tyler1, Neetu Singh2, Matthew J McNally3

  • 1Division of Neonatology, Department of Pediatrics, Children's Hospital at Dartmouth, and the Leadership Preventive Medicine Residency, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. michelle.d.tyler@hitchcock.org.

Respiratory Care
|May 23, 2019
PubMed

Insights

Improving respiratory care for very low birthweight (VLBW) infants significantly reduced the need for home oxygen. This quality improvement project in a neonatal ICU lowered discharge rates on oxygen and chronic lung disease in VLBW infants.

Area of Science:

  • Neonatal Medicine
  • Pediatric Pulmonology
  • Quality Improvement Science

Background:

  • Chronic lung disease is a major complication for very low birthweight (VLBW) infants.
  • Discharge home on oxygen imposes substantial burdens on families.
  • Current convalescent respiratory practices require optimization to reduce oxygen dependency.

Purpose of the Study:

  • To decrease the proportion of VLBW infants discharged home requiring supplemental oxygen.
  • To enhance respiratory outcomes in VLBW infants through improved care practices.

Main Methods:

  • A prospective quality improvement initiative was conducted in a neonatal intensive care unit (NICU).
  • Interventions included a room air challenge, oxygen reference chart, and standardized oxygen delivery guidelines, implemented via Plan-Do-Study-Act cycles.
  • Statistical process control charts monitored primary and secondary outcomes, including chronic lung disease rates and time off respiratory support.

Main Results:

  • The percentage of VLBW infants discharged on oxygen decreased significantly from 34.4% to 18.5% and 21.7% in subsequent years.
  • The incidence of chronic lung disease also saw a reduction from 31.2% to 25.4%.
  • Key metrics such as discharge age, weight, and readmission rates remained stable.

Conclusions:

  • Standardizing convalescent respiratory care effectively improved respiratory morbidity in VLBW infants.
  • These evidence-based interventions offer a model for other NICUs facing similar challenges.
  • Optimizing respiratory care can reduce long-term complications and family burden in preterm infants.
Abstract

Keywords:
bronchopulmonary dysplasiachronic lung diseaseneonatal intensive care unitoxygen inhalation therapypremature infantsquality improvementvery low birthweight

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