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Decreasing Exposure to Mechanical Ventilation in Extremely Preterm Infants.
Samuel J Gentle1,2, Colm P Travers1, Lindy Winter1
1Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, Alabama.
Pediatrics
|November 5, 2025
Summary
Reducing invasive mechanical ventilation duration in extremely preterm infants significantly lowered bronchopulmonary dysplasia (BPD) or death rates. A systematic approach improved outcomes for vulnerable newborns.
Area of Science:
- Neonatalogy
- Pediatric Critical Care
- Respiratory Medicine
Background:
- Provider variability in mechanical ventilation weaning practices can lead to prolonged invasive ventilation.
- Prolonged ventilation increases the risk of bronchopulmonary dysplasia (BPD) in extremely preterm infants.
Purpose of the Study:
- To reduce the proportion of infants (24-28 6/7 weeks gestation) exposed to invasive ventilation for over 7 days by 25% within 12 months.
- To decrease the incidence of BPD or death in this vulnerable infant population.
Main Methods:
- A single-center quality improvement initiative implemented between January 2021 and March 2023.
- Interventions included establishing consensus on ventilation practices, a bedside weaning readiness tool, empowering respiratory therapists, and a ventilation dashboard.
- Statistical process control charts were used to analyze measures.
Main Results:
- The initiative included 340 infants with a median gestational age of 26 6/7 weeks.
- The proportion of infants ventilated for over 7 days decreased from 44% to 25%.
- Rates of BPD or death decreased from 55% to 40%.
Conclusions:
- Systematic ventilator weaning in extremely preterm infants is associated with reduced invasive ventilation duration.
- This systematic approach also led to a significant decrease in BPD or death rates.
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