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The Impact of Standardized Respiratory Care Practices on Delivery Room Intubation Frequency and NICU Ventilator Days

Poonam Thakore1,2, Betté Ford1,2, Jamille Rancourt1

  • 1Connecticut Children's Medical Center, Hartford, Connecticut, United States.

American Journal of Perinatology
|October 27, 2025
PubMed

Insights

Implementing standardized respiratory care for very low birth weight (VLBW) infants significantly reduced delivery room intubation and ventilation days, preventing chronic lung disease (CLD).

Area of Science:

  • Neonatal Medicine
  • Pediatric Respiratory Medicine
  • Public Health

Background:

  • Chronic lung disease (CLD) is a significant concern for very low birth weight (VLBW) infants, with mechanical ventilation identified as a key risk factor.
  • A notable increase in CLD incidence from 15% in 2017 to 30.9% in 2018 highlighted the need for practice review.

Purpose of the Study:

  • To decrease the incidence of chronic lung disease in very low birth weight infants.
  • To reduce delivery room intubation rates and overall mechanical ventilation exposure in VLBW infants.

Main Methods:

  • A multidisciplinary team reviewed delivery room and initial ventilation practices.
  • Sequential interventions were implemented using Plan-Do-Study-Act (PDSA) cycles, focusing on standardized respiratory care.
  • Data from 390 VLBW infants admitted between January 2017 and January 2022 were analyzed.

Main Results:

  • Delivery room intubation rates for inborn VLBW infants decreased from 44% to 18%.
  • Total ventilation days per 100 patient days decreased from 19 to 12.
  • Special cause variation was observed in both outcome metrics, indicating significant improvement.

Conclusions:

  • Standardized respiratory care practices effectively reduce delivery room intubation and total ventilation days in VLBW infants.
  • Protective lung strategies are crucial for limiting lung injury and preventing CLD.
  • Implementing a resuscitation bundle can enhance delivery room processes and improve outcomes.

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