Structured implementation of a bubble-CPAP program to reduce bronchopulmonary dysplasia in preterm infants

Area of Science:

• Neonatal Medicine
• Respiratory Care
• Clinical Implementation Science

Background:

• Bronchopulmonary dysplasia (BPD) is a significant complication in premature infants, with existing treatments showing variable effectiveness.
• The effectiveness of Continuous Positive Airway Pressure (CPAP) may be influenced by program implementation rather than solely device performance.
• Structured implementation of CPAP programs is hypothesized to improve clinical outcomes in neonates.

Purpose of the Study:

• To describe a structured bubble-CPAP (b-CPAP) program incorporating training, guidelines, skills practice, and checklists.
• To evaluate the clinical correlates and outcomes associated with the implementation of this structured b-CPAP program.
• To assess the impact of a systematic b-CPAP program on survival and BPD rates in preterm infants.

Main Methods:

• The study involved a descriptive implementation of a b-CPAP program for preterm infants with birthweight <1500g.
• Infants with gestational age <22 weeks, delivery room mortality, genetic, or surgical conditions were excluded.
• Outcomes were compared before and after program implementation using bivariate and logistic regression analyses, adjusting for confounders.

Main Results:

• Survival without BPD improved from 59% to 74% (aOR=1.86), and BPD rates decreased significantly from 25.2% to 6.9% (aOR=0.12).
• Median oxygen use decreased from 26 to 15 days (p=0.03), while median CPAP use increased from 10 to 27 days (p<0.0001).
• The incidence of pneumothorax did not significantly change (4.1% to 6.4%).

Conclusions:

• A structured, stepwise implementation of a b-CPAP program was associated with substantial improvements in survival without BPD and reduced BPD prevalence.
• Systematic implementation strategies are crucial for enhancing the reproducibility and effectiveness of CPAP use in neonatal intensive care.
• The findings support the integration of structured programs to optimize respiratory support for premature infants.