Related Experiment Video

Updated: Sep 25, 2025

Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
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Hemodynamic Quality Improvement Bundle to Reduce the Use of Inotropes in Extreme Preterm Neonates

Sujith Kumar Reddy Gurram Venkata1, Ankur Srivastava1, Prashanth Murthy1

  • 1Section of Neonatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Room B4-286, 28 Oki drive NW, Calgary, AB, T3B 6A8, Canada.

Paediatric Drugs
|April 26, 2022
PubMed

Insights

A quality improvement bundle significantly reduced inotrope use and brain injuries in preterm neonates. This approach improved care without increasing cystic periventricular leukomalacia rates.

Area of Science:

  • Neonatal Medicine
  • Pediatric Cardiology
  • Quality Improvement Science

Background:

  • Premature neonates (<29 weeks) often require inotropic support.
  • Inotrope use in neonates is associated with significant morbidities.
  • Optimizing care for high-risk preterm infants is crucial.

Purpose of the Study:

  • To evaluate a quality improvement (QI) bundle's effect on inotrope use.
  • To assess the impact of the QI bundle on neonatal morbidities, particularly brain injury.
  • To determine if the QI bundle affects the incidence of cystic periventricular leukomalacia (cPVL).

Main Methods:

  • A QI bundle was implemented for preterm neonates (<29 weeks) in a level III NICU.
  • The bundle focused on the first 72 hours, including delayed cord clamping and revised hypotension criteria.
  • Inotrope use rates and cPVL incidence were compared pre- and post-bundle implementation.

Main Results:

  • QI bundle significantly reduced overall inotrope use (24% to 7%), dopamine (18% to 5%), and dobutamine (17% to 4%).
  • Acute brain injury rates decreased significantly (any grade: 34% to 20%; severe: 15% to 6%).
  • No significant difference in cPVL incidence was observed (0.8% vs 1.4%).

Conclusions:

  • A bundled quality improvement approach effectively reduced inotrope administration in preterm infants.
  • The QI bundle was associated with a significant decrease in brain injuries.
  • This strategy improved outcomes without adversely affecting cPVL rates.
Abstract

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