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Updated: Jun 11, 2025

Transcutaneous Microcirculatory Imaging in Preterm Neonates
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Improving Time to Goals of Care Discussions in Invasively Ventilated Preterm Infants

Samuel J Gentle1,2, Charli Cohen3, Waldemar A Carlo1

  • 1Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.

Pediatrics
|October 3, 2024
PubMed

Insights

Timely goals of care discussions for preterm infants with bronchopulmonary dysplasia (BPD) requiring prolonged ventilation were improved. This quality initiative reduced the postmenstrual age (PMA) for these discussions and tracheostomy placement.

Area of Science:

  • Neonatal Medicine
  • Pediatric Pulmonology
  • Quality Improvement Science

Background:

  • Identifying preterm infants with bronchopulmonary dysplasia (BPD) needing tracheostomy can delay goals of care (GOC) discussions.
  • Early identification of infants unlikely to be liberated from ventilation can facilitate timely GOC discussions and reduce tracheostomy dependence.

Purpose of the Study:

  • To reduce the postmenstrual age (PMA) of GOC discussions by 20% in infants with BPD and prolonged invasive ventilatory support.
  • To improve the timeliness of care planning for ventilator-dependent infants.

Main Methods:

  • A quality improvement initiative was conducted at the University of Alabama at Birmingham.
  • Infants born <32 weeks' gestation requiring invasive ventilation ≥2 weeks beyond 36 weeks' PMA were included.
  • Interventions included consensus identification of at-risk infants, monthly multidisciplinary tracheostomy meetings, and family education.

Main Results:

  • Analysis included 79 infants; 44 received tracheostomy or died.
  • Time to GOC discussions decreased from 62 to 51 weeks' PMA, linked to multidisciplinary conferences.
  • Average PMA at tracheostomy decreased from 80 to 63 weeks, with no change in tracheostomy frequency or discordant GOC discussions.

Conclusions:

  • Standardizing GOC discussions in ventilator-dependent BPD infants reduced the PMA for both GOC discussions and tracheostomy placement.
  • This quality improvement initiative demonstrated successful early intervention in care planning.
Abstract

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