An Improvement Project to Lower Pneumothorax Rates in Neonates Born at 36 Weeks' Gestational Age or Beyond

Our institutional data revealed high pneumothorax rates in term neonates resuscitated in the delivery room (DR). Other studies have reported that high rates of continuous positive airway pressure (CPAP) in the DR are associated with increased pneumothorax rates. We sought to test the hypothesis that quality improvement efforts to reduce the use of CPAP in the DR would be associated with a reduced incidence of pneumothorax.

We performed a series of interventions to make minor revisions to our DR respiratory care algorithm focusing on optimizing CPAP use by providing education to the DR team to the revisions. For neonates born at 36 weeks of gestation or beyond, we evaluated the use of CPAP in the DR and the number of births between pneumothorax events before and after the algorithm was implemented. We used statistical process control charts to assess improvement.

CPAP utilization in the DR for infants 36 weeks or older decreased from 3.4% to 1.0%. Frequency of pneumothorax decreased, with births between pneumothorax events increasing from 293 to 530. We found no increase in the number of neonates requiring a higher level of care with respiratory distress.

We found that a reduction in the use of CPAP in DR was associated with a decrease in the rate of pneumothorax without an increase in neonates requiring additional care with respiratory distress.