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Using a Bundle Approach to Prevent Bronchopulmonary Dysplasia in Very Premature Infants
Devon Ratliff-Crain1, Brenda Wallingford, Lisa Jorgenson
1Children's Minnesota, Minneapolis (Dr Ratliff-Crain); College of Nursing, Creighton University Omaha, Nebraska (Dr Wallingford); and Avera McKennan Hospital and University Center, Sioux Falls, South Dakota (Ms Jorgenson).
Insights
A new care bundle reduced bronchopulmonary dysplasia (BPD) rates and severity in premature infants without increasing hospital stays. This approach improved respiratory support and medication use for vulnerable newborns.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Healthcare Quality Improvement
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting 20-30% of infants born before 32 weeks gestation.
- BPD diagnosis is based on oxygen needs at 36 weeks corrected age or discharge.
- This condition elevates healthcare costs, mortality, and risks of long-term respiratory and neurosensory issues.
Purpose of the Study:
- To decrease the incidence and severity of BPD in very premature infants.
- To achieve BPD reduction without extending hospitalization duration.
Main Methods:
- Implemented a multidisciplinary care bundle including respiratory support and medication guidelines.
- Utilized a noninvasive ventilation algorithm in the delivery room for infants born before 32 weeks gestation.
- Compared outcomes of infants managed with the bundle in 2019 to a control group from 2017.
Main Results:
- The BPD prevention bundle led to reduced oxygen use at discharge for very premature infants.
- No increase in length of hospitalization was observed.
- Decreased use of invasive mechanical ventilation and reduced BPD severity were noted.
Conclusions:
- A multidisciplinary bundle approach effectively lowers BPD rates in very premature infants.
- Future efforts should prioritize delivery room management and noninvasive ventilation optimization.
- Further research is needed on optimal ventilation, surfactant, and corticosteroid use in premature infants.
Background:
Bronchopulmonary dysplasia (BPD) is a chronic lung disease that affects about 20% to 30% of infants born at less than 32 weeks of gestation. Diagnosis is made if an infant requires oxygen therapy at 36 weeks' corrected age or discharge home. BPD increases healthcare costs, mortality rates, and risk of long-term respiratory complications and neurosensory impairments.
Purpose:
The purpose of this project was to improve rates and severity of BPD in very premature infants without increasing length of hospitalization.
Methods:
A multidisciplinary care bundle involving respiratory support and medication use guidelines was created and implemented along with a noninvasive ventilation algorithm for the delivery room. This bundle was utilized for infants born in a Midwest hospital in 2019 at less than 32 weeks of gestation and the outcomes were compared to infants born in 2017.
Results:
Implementation of this BPD prevention bundle contributed to a decrease in the use of oxygen at discharge for very premature infants without increasing length of hospitalization. Use of invasive mechanical ventilation and the severity of BPD also decreased.
Implications For Practice And Research:
A multidisciplinary bundle approach can be successful in decreasing the rates of BPD for very premature infants. Future quality improvement projects should focus on improving delivery room management of extremely premature infants, with an emphasis on optimizing noninvasive ventilation strategies. More research is still needed to determine the best method of ventilation for premature infants and the best utilization of surfactant and corticosteroids.
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