A Quality Improvement Initiative to Reduce Bronchopulmonary Dysplasia in a Level 4 NICU—Golden Hour Management of Respiratory Distress Syndrome in Preterm Newborns

Andrew M Dylag,Karen E Paul,Jeffrey M Meyers,Jamey Tulloch

doi:10.3390/children8040301

Andrew M Dylag, Karen E Paul + Show 2 more

Open Access

https://doi.org/10.3390/children8040301

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Abstract

Background: Prevention of chronic lung disease (CLD) requires a multidisciplinary approach spanning from the delivery room to Neonatal Intensive Care Unit (NICU) discharge. In 2018, a quality improvement (QI) initiative commenced in a level 4 NICU with the goal of decreasing chronic lung disease rates below the Vermont Oxford Network (VON) average of 24%. Methods: Improvement strategies focused on addressing the primary drivers of ventilation strategies, surfactant administration, non-invasive ventilation, medication use, and nutrition/fluid management. The primary outcome was VON CLD, defined as need for mechanical ventilation and/or supplemental oxygen use at 36 weeks postmenstrual age. Statistical process control charts were used to display and analyze data over time. Results: The overall CLD rate decreased from 33.5 to 16.5% following several interventions, a 51% reduction that has been sustained for >18 months. Changes most attributable to this include implementation of the “golden hour” gestational age (GA) based delivery room protocol that encourages early surfactant administration and timely extubation. Fewer infants were intubated across all GA groups with the largest improvement among infants 26–27 weeks GA. Conclusions: Our efforts significantly decreased CLD through GA-based respiratory guidelines and a comprehensive, rigorous QI approach that can be applicable to other teams focused on improvement.

Highlights

Bronchopulmonary Dysplasia (BPD) and Chronic Lung Disease (CLD) are among the most common complications of premature birth
chronic lung disease (CLD)-reducing interventions start in the delivery room with timely delivery of exogenous surfactant and extend to the Neonatal Intensive Care Unit (NICU) where strategies are required for gentle ventilation, timely extubation, effective use of non-invasive ventilation, and optimized nutrition and growth
Standardized, evidence-based approaches are needed in NICUs to prevent secondary lung injury and reduce BPD/CLD

Summary

Introduction

Bronchopulmonary Dysplasia (BPD) and Chronic Lung Disease (CLD) are among the most common complications of premature birth. Multiple factors contribute to BPD/CLD including mechanical ventilation, oxygen toxicity, infection, inflammation, and preventing secondary lung injury has been shown to reduce morbidity and mortality in preterm infants [3]. CLD-reducing interventions start in the delivery room with timely delivery of exogenous surfactant and extend to the Neonatal Intensive Care Unit (NICU) where strategies are required for gentle ventilation, timely extubation, effective use of non-invasive ventilation, and optimized nutrition and growth. Standardized, evidence-based approaches are needed in NICUs to prevent secondary lung injury and reduce BPD/CLD. Prevention of chronic lung disease (CLD) requires a multidisciplinary approach spanning from the delivery room to Neonatal Intensive Care Unit (NICU) discharge. In 2018, a quality improvement (QI) initiative commenced in a level 4 NICU with the goal of decreasing chronic lung disease rates below the Vermont Oxford Network (VON) average of 24%. Conclusions: Our efforts significantly decreased CLD through GA-based respiratory guidelines and a comprehensive, rigorous QI approach that can be applicable to other teams focused on improvement

Methods

Results

Conclusion