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Improving Respiratory Support Practices to Reduce Chronic Lung Disease in Premature Infants
Bernadette M Levesque1,2, Laura Burnham3, Natasha Cardoza4
1Division of Neonatology, Boston Medical Center, Boston, Mass.
Insights
Implementing optimized respiratory care, including continuous positive airway pressure (CPAP), significantly reduced chronic lung disease (CLD) in very low birth weight (VLBW) infants. This intervention improved infant respiratory outcomes without increasing mortality or complications.
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Care
- Clinical Quality Improvement
Background:
- Chronic lung disease (CLD) is a significant concern for very low birth weight (VLBW) infants born prematurely.
- Optimizing respiratory support, such as continuous positive airway pressure (CPAP), is crucial for managing these vulnerable infants.
Purpose of the Study:
- To decrease the incidence of CLD in VLBW infants (born before 33 weeks gestation) through a bundle of respiratory care practices.
- To optimize the delivery and use of CPAP in the neonatal intensive care unit.
Main Methods:
- A multidisciplinary task force implemented interventions using 6 plan-do-study-act cycles.
- Key outcomes measured included CLD incidence, intubation rates, CPAP use, ventilation duration, and oxygen exposure.
- Process measures assessed compliance with respiratory care bundle components; balancing measures monitored mortality and prematurity complications.
Main Results:
- CLD incidence decreased by 55.5% (from 37.5% to 16.7%) post-intervention.
- Infants required less intubation (87.5% to 40.8%), ventilation (11.2 to 6.1 days), and supplemental oxygen (44.1 to 25.4 days).
- CPAP use increased, and there were no significant differences in mortality or major complications; patent ductus arteriosus incidence decreased significantly (60% to 33%).
Conclusions:
- A respiratory care bundle and optimized CPAP delivery effectively reduced CLD incidence by over 50% in VLBW infants.
- The intervention improved respiratory support outcomes without adverse effects on mortality or other complications.
- A significant reduction in patent ductus arteriosus was also observed.
Introduction:
We implemented a bundle of respiratory care practices and optimized delivery of continuous positive airway pressure (CPAP) to reduce the incidence of chronic lung disease (CLD) among very low birth weight (VLBW) infants born before 33 weeks gestation.
Methods:
Our multidisciplinary task force utilized 6 plan-do-study-act cycles to test our interventions. The primary outcome was the quarterly percentage of infants diagnosed with CLD; other outcomes included the percentage of infants initially managed with CPAP, intubation <72 hours of age, use of a nasal cannula, and days of ventilation, oxygen, and/or CPAP. Process measures included compliance with each of the 5 components of the bundle; balancing measures included mortality and complications of prematurity.
Results:
Demographics were similar in the 55 infants born before and 76 infants born after the task force interventions, except for gestational age, which was lower before. CLD decreased by 55.5% (from 37.5% to 16.7%). Quarterly percentage of infants requiring intubation decreased from 87.5% to 40.8%. Quarterly average days of ventilation decreased from 11.2 to 6.1, and days of supplemental oxygen declined from 44.1 to 25.4, while the use of CPAP increased. There were no differences in adverse events including mortality, pneumothorax, use of postnatal steroids, or any retinopathy of prematurity. The incidence of patent ductus arteriosus declined from 60% to 33% (P < 0.01).
Conclusions:
We reduced the incidence of CLD among our very low birth weight infants born before 33 weeks gestation by over 50% without increasing any measured adverse outcomes. The incidence of patent ductus arteriosus declined.
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