Quality improvement programme to improve compliance with initial respiratory support guideline at preterm birth

Abstract

Aim CPAP (continuous airway pressure) use as respiratory support from birth increases the proportion of babies who survive without bronchopulmonary dysplasia. Although we introduced a guideline for CPAP use in 2015, our intubation rate remained high (61.7%). We aimed to reduce the intubation rate into the interquartile range for the Vermont Oxford Neonatal (VON) network. Methods A multi‐disciplinary team was established. Data relating to resuscitation in all babies born before 32 weeks gestation or with a birth weight below 1500 g during 2017/2018 were collected prospectively. Episodes when CPAP was not used were identified, and series of Plan, Do, See, Act (PDSA) cycles performed. Performance data were displayed graphically to staff along with lessons learnt. Results The rate of intubation at birth for VLBW babies fell from 61.7% into the VON interquartile range at 49.6% during the project (P = .02). Intubation rate in babies born between 26 and 30 weeks gestation fell from 66% to 41% (the VON network mean). Conclusion The NICU is a complex system. Altering clinical practice is challenging, even with good clinical evidence to support change. Quality improvement using frequent PDSA cycles enabled us to alter our practice. Preterm intubation rates are now within the desired range.

Can high-flow nasal cannula reduce the risk of bronchopulmonary dysplasia compared with CPAP in preterm infants? A systematic review and meta-analysis

“…CPAP is recommended worldwide, by the World Health Organization, as first-line therapy for the treatment of premature newborns with respiratory disorders since birth, significantly improving oxygenation, when compared to HFNC, which may justify its greater popularity [19,32,33]. The HFNC application systems, currently available, do not measure pressure in the airways, which can lead to the release of excessive pressure, contributing to the appearance of lung lesions and consequently contributing to the development of BPD [33].…”

Maintaining Normothermia in Preterm Babies during Stabilisation with an Intact Umbilical Cord

“…Collaboration and clear communication with our obstetric, midwifery, medical engineering and estate staff colleagues were vital to facilitating the success of this project. We have used this approach previously to successfully drive change in our unit [ 8 , 25 ]. The team approach (rather than a top-down approach) promotes ownership of the project, generates enthusiasm and helps create a genuine desire for success.…”

Is There a Decreased Risk of Bronchopulmonary Dysplasia Treated With High-Flow Nasal Cannulae Compared to Cpap? A Systematic Review and Meta-Analysis of Randomized Clinical Trial

“…CPAP is recommended worldwide, by the World Health Organization, as rst-line therapy for the treatment of premature newborns with respiratory disorders since birth, signi cantly improving oxygenation, when compared to HFNC, which may justify its greater popularity 19,32,33 . The HFNC application systems, currently available, do not measure pressure in the airways, which can lead to the release of excessive pressure, contributing to the appearance of lung lesions and consequently contributing to the development of BPD 33 .…”