A multidisciplinary quality improvement effort to reduce bronchopulmonary dysplasia incidence

Bapat, Roopali; Nelin, Leif D.; Shepherd, Edward G.; Ryshen, Greg; Elgin, Amee; Bartman, Thomas

doi:10.1038/s41372-019-0574-8

Cited by 20 publications

(4 citation statements)

References 28 publications

(33 reference statements)

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“…Our finding of a moderate correlation between center rate of later corticosteroid initiation and center rate of severe BPD is interesting. Variation in practices and outcomes can provide insight into potentially better practices, and a collaborative quality improvement initiative that aims to decrease the rate of later corticosteroid treatment as part of a bundle to reduce BPD seems reasonable 23–25 . However, it is important to remember that while such an enterprise can help decrease variation in corticosteroid initiation, a consequent reduction in BPD is not guaranteed.…”

Section: Discussionmentioning

confidence: 99%

Association of time of first corticosteroid treatment with bronchopulmonary dysplasia in preterm infants

Cuna

Lagatta

Savani

et al. 2021

Pediatric Pulmonology

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Objective To evaluate the association between the time of first systemic corticosteroid initiation and bronchopulmonary dysplasia (BPD) in preterm infants. Study design A multi‐center retrospective cohort study from January 2010 to December 2016 using the Children's Hospitals Neonatal Database and Pediatric Health Information System database was conducted. The study population included preterm infants <32 weeks' gestation treated with systemic corticosteroids after 7 days of age and before 34 weeks' postmenstrual age. Stepwise multivariable logistic regression was used to assess the association between timing of corticosteroid initiation and the development of Grade 2 or 3 BPD as defined by the 2019 Neonatal Research Network criteria. Results We identified 598 corticosteroid‐treated infants (median gestational age 25 weeks, median birth weight 760 g). Of these, 47% (280 of 598) were first treated at 8–21 days, 25% (148 of 598) were first treated at 22–35 days, 14% (86 of 598) were first treated at 36–49 days, and 14% (84 of 598) were first treated at >50 days. Infants first treated at 36‐49 days (aOR 2.0, 95% CI 1.1–3.7) and >50 days (aOR 1.9, 95% CI 1.04–3.3) had higher independent odds of developing Grade 2 or 3 BPD when compared to infants treated at 8–21 days after adjusting for birth characteristics, admission characteristics, center, and co‐morbidities. Conclusions Among preterm infants treated with systemic corticosteroids in routine clinical practice, later initiation of treatment was associated with a higher likelihood to develop Grade 2 or 3 BPD when compared to earlier treatment.

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Section: Discussionmentioning

confidence: 99%

Association of time of first corticosteroid treatment with bronchopulmonary dysplasia in preterm infants

Cuna

Lagatta

Savani

et al. 2021

Pediatric Pulmonology

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“…In exploratory analysis of our cohort, SGA status at birth was not significantly associated with the development of BPD. Infants with severe BPD are at high risk for neurodevelopment impairment, and higher health care utilization rates post NICU discharge, including need for home oxygen and ventilator support, so reducing rates of severe BPD is particularly significant ( 10 , 19 , 20 ). Future QI initiatives may primarily focus on this cohort of infants to further reduce the rate of severe BPD ( 10 , 20 ).…”

Section: Discussionmentioning

confidence: 99%

Respiratory support strategies in the prevention of bronchopulmonary dysplasia: A single center quality improvement initiative

et al. 2022

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Background and objectivesBronchopulmonary dysplasia (BPD) continues to be a significant morbidity affecting very preterm infants, despite multiple advancements in therapies to treat respiratory distress syndrome and prevent BPD. Local quality improvement (QI) efforts have shown promise in reducing unit or system-wide rates of BPD. In preterm infants born between 23- and 32-weeks' gestation, our aim was to decrease the rate of BPD at 36 weeks corrected gestational age from 43% to 28% by January 2019.MethodsDirected by a multidisciplinary respiratory QI team, we gradually implemented the following interventions to reach our aim: (1) early initiation of non-invasive ventilation in the delivery room, (2) initiation of caffeine prior to 24 h of life, (3) administration of early selective surfactant per a well-defined guideline, (4) continuation of non-invasive ventilation until 32 and 0/7 weeks corrected gestational age (CGA), and (5) a revision of the early selective surfactant guideline. Outcome measures included rates of BPD, and process measures included compliance with the above interventions.ResultsA total of 509 infants with an average gestational age of 29 1/7 weeks and birth weight of 1,254 (SD±401) grams were included. The rate of BPD in our unit decreased from a baseline of 43% to 19% from the start of the project in October 2016 until the first quarter of 2022 (p < 0.00001). The greatest reductions in BPD rates were seen after the initiation of the guideline to extend non-invasive ventilation until 32 0/7 weeks CGA. The rate of severe BPD decreased from 22% to 9%.ConclusionsIn preterm infants born between 23- and 32-weeks' gestation, our local QI interventions to reduce rates of BPD were associated with a reduction in rates by 56%. Increased use of antenatal steroids and higher birth weights post- vs. pre-intervention may have contributed to this successes.

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“…However, as survival has increased, the rates of BPD have also increased [ 1 ]. These increases have occurred despite the development of multiple interventions that have been associated with reduced risk of BPD, including non-invasive respiratory support, surfactant, gentle invasive ventilation, and skin-to-skin care [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

Managing established bronchopulmonary dysplasia without using routine blood gas measurements

Kielt,

Eldredge,

Shepherd

et al. 2024

J Perinatol

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Objective Routine blood gas measurements are common in infants with severe bronchopulmonary dysplasia (sBPD) and are a noxious stimulus. We developed a guideline-driven approach to evaluate the care of infants with sBPD without routine blood gas sampling in the chronic phase of NICU care (after diagnosis at 36 weeks PMA). Study design We examined blood gas utilization and outcomes in our sBPD inpatient care unit using data collected between 2014 and 2020. Results 485 sBPD infants met inclusion criteria, and 303 (62%) never had a blood gas obtained after 36 weeks PMA. In infants who had blood gas measurements, the median number of total blood gases per patient was only 4 (IQR 1–10). We did not identify adverse effects on hospital outcomes in patients without routine blood gas measurements. Conclusions We found that patients with established BPD could be managed without routine blood gas analyses after 36 weeks PMA.

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A multidisciplinary quality improvement effort to reduce bronchopulmonary dysplasia incidence

Cited by 20 publications

References 28 publications

Association of time of first corticosteroid treatment with bronchopulmonary dysplasia in preterm infants

Association of time of first corticosteroid treatment with bronchopulmonary dysplasia in preterm infants

Respiratory support strategies in the prevention of bronchopulmonary dysplasia: A single center quality improvement initiative

Managing established bronchopulmonary dysplasia without using routine blood gas measurements

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