Hemodynamic Quality Improvement Bundle to Reduce the Use of Inotropes in Extreme Preterm Neonates.

Abstract

We evaluated the effect of the quality improvement (QI) bundle on the rate of inotrope use and associated morbidities. We included inborn preterm neonates born at <29 weeks admitted to level III NICU. We implemented a QI bundle focusing on the first 72 h from birth which included delayed cord clamping, avoidance of routine echocardiography, the addition of clinical criteria to the definition of hypotension, factoring iatrogenic causes of hypotension, and standardization of respiratory management. The rate of inotropes use was compared before and after implementing the care bundle. Incidence of cystic periventricular leukomalacia (cPVL) was used as a balancing measure. QI bundle implementation was associated with significant reduction in overall use of inotropes (24 vs 7%, p<0.001), dopamine (18 vs 5%, p<0.001), and dobutamine (17 vs 4%, p<0.001). Rate of acute brain injury decreased significantly: acute brain injury of any grade (34 vs 20%, p<0.001) and severe brain injury (15 vs 6%, p<0.001). There was no difference in the incidence of cPVL (0.8 vs 1.4%, p=0.66). Associations remained significant after adjusting for confounding factors. A quality improvement bundled approach resulted in a reduction in inotropes use and associated brain morbidities in premature babies.