Reduction in the Incidence of Chronic Lung Disease in Very Low Birth Weight Infants: Results of a Quality Improvement Process in a Tertiary Level Neonatal Intensive Care Unit

Birenbaum, Howard J.; Dentry, Abby; Cirelli, Jane; Helou, Sabah; Pane, Maria A.; Starr, Karen P.; Melick, Clifford F.; Updegraff, Linda; Arnold, Cynthia; Tamayo, Angela; Torres, Virma; Gungon, Norma; Liverman, S.

doi:10.1542/peds.2007-2872

Cited by 70 publications

(37 citation statements)

References 31 publications

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“…Compared to non-EnCPAP neonates, EnCPAP neonates had reduced mortality, mechanical ventilation, BPD and PH, without an increased risk of pneumothorax. The lower rates of endotracheal intubation at birth and surfactant therapy despite more RDS in our EnCPAP neonates were similar to those reported by others [13,14,15,16,17,18,19,20,21]. Contrary to studies reported elsewhere, our EnCPAP neonates had a significantly lower mortality at discharge [3,4,22] and no increased risk of IVH [22].…”

Section: Discussionsupporting

confidence: 87%

Impact and Challenges of Early Continuous Positive Airway Pressure Therapy for Very Low Birth Weight Neonates in a Developing Country

Boo

Cheah²,

Neoh³

et al. 2016

Neonatology

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Background: Early nasal continuous positive airway pressure (EnCPAP) therapy after birth for very low birth weight (VLBW; <1,500 g) neonates has been reported to be beneficial in developed countries. Its benefits in developing countries, such as Malaysia, are unknown. Objectives: This study aimed to determine EnCPAP rates in 36 neonatal intensive care units of the Malaysian National Neonatal Registry (MNNR) in 2013, to compare the outcomes of VLBW neonates with and without EnCPAP, and to determine whether the availability of CPAP facilities and unit policies played a significant role in EnCPAP rates. Methods: First, a retrospective cohort study was conducted of VLBW neonates born in the hospitals participating in the study without major congenital abnormalities in the MNNR. This was followed by a questionnaire survey of these hospitals focussed on CPAP facilities and unit policies. Results: Of the 2,823 neonates, 963 (34.1%) received EnCPAP. Amongst EnCPAP neonates significantly fewer deaths were recorded (10.9 vs. 21.7%; p < 0.001), less bronchopulmonary dysplasia was observed (BPD; 8.0 vs. 11.7%; p = 0.002) and fewer mechanical ventilation days were necessary (p < 0.001) than in non-EnCPAP neonates. Logistic regression analysis showed that EnCPAP was significantly associated with a lower mortality (adjusted OR 0.623; 95% CI 0.472, 0.824; p = 0.001) and BPD among survivors (adjusted OR 0.585; 95% CI 0.427, 0.802; p = 0.001). The median EnCPAP rate of the 36 hospitals was 28.4% (IQR 14.3-38.7). Hospitals with CPAP facilities in the delivery suites (p = 0.001) and during transport (p = 0.001) and a policy for EnCPAP (p = 0.036) had significantly higher EnCPAP rates. Conclusion: EnCPAP reduced mortality and BPD in Malaysian VLBW neonates. Resource-strapped developing countries should prioritise the use of this low-cost therapy.

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Section: Discussionsupporting

confidence: 87%

Impact and Challenges of Early Continuous Positive Airway Pressure Therapy for Very Low Birth Weight Neonates in a Developing Country

Boo

Cheah²,

Neoh³

et al. 2016

Neonatology

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“…14 The sustained improvements we observed in respiratory outcomes for VLBW newborns mainly occurred 1 year after implementation of bnCPAP, early surfactant treatment, and rapid extubation strategy, and continued to show improving trends in respiratory outcomes during the subsequent 3 years, consistent with similar improvements reported by others after several years of use. 11,17 Our study expands the VLBW population size and includes a larger number of VLBW babies and ELBW babies Ͻ 27 weeks gestational age.…”

Section: Discussionmentioning

confidence: 99%

Bubble Nasal CPAP, Early Surfactant Treatment, and Rapid Extubation Are Associated With Decreased Incidence of Bronchopulmonary Dysplasia in Very-Low-Birth-Weight Newborns: Efficacy and Safety Considerations

et al. 2013

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BACKGROUND: Current literature has been inconsistent in demonstrating that minimizing the duration of mechanical ventilation in very-low-birth-weight (VLBW) newborns reduces lung damage. OBJECTIVE: To determine if introduction of bubble nasal CPAP (bnCPAP), early surfactant treatment, and rapid extubation (combined bnCPAP strategy) in our community-based neonatal ICU reduced bronchopulmonary dysplasia (BPD). METHODS: This was a 7-year retrospective, single-institution review of respiratory outcomes in 633 VLBW babies before and after introduction of the combined bnCPAP strategy. Coincident changes in newborn care were taken into account with a logistic regression model. RESULTS: The average percentage of VLBW newborns with BPD decreased to 25.8% from 35.4% (P ‫؍‬ .02), reaching a minimum in the last post-bnCPAP year of 22.1% (P ‫؍‬ .02). When other coincident changes in newborn care during the study years were taken into account, VLBW babies in the post-bnCPAP years had a 43% lower chance of developing BPD (P ‫؍‬ .003, odds ratio 0.43, 95% CI 0.25-0.75). Decreases occurred in mechanical ventilation and the percentage of infants discharged on diuretics and on supplemental oxygen. Among the subset of extremely-low-birth-weight newborns, improved respiratory outcomes in the post-bnCPAP years, as compared to outcomes in the pre-bnCPAP years, included an increase in the percentage alive and off mechanical ventilation at 1 week postnatal age (P < .001), a more rapid extubation rate (P < .03), a decrease in the median days on mechanical ventilation (P ‫؍‬ .002), and a decrease in the percentage with BPD plus died (P ‫؍‬ .01). Post-bnCPAP extremely-low-birth-weight babies had a statistically significant decrease in retinopathy of prematurity, an increase in low-grade intraventricular hemorrhage, and a decrease in ductal ligations. CONCLUSIONS: A combined BnCPAP strategy may contribute to a reduction of BPD, after adjusting for concurrent treatments.

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“…Many of these interventions were in line with current evidence-based practice recommendations and achieved by other QI efforts to reduce morbidities. 8,9,[21][22][23] Significant reductions in nosocomial infections and growth restriction were credited to consistent team application of practice. Although there were no specific process changes targeting a reduction in infection, usual processes, such as strict adherence to central line care and antibiotic stewardship, were further standardized by the team.…”

Section: Figurementioning

confidence: 99%

Small Baby Unit Improves Quality and Outcomes in Extremely Low Birth Weight Infants

2015

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The survival rates for extremely low birth weight (ELBW) infants have improved, but many are discharged from the hospital with significant challenges. Our goal was to improve outcomes for this population by using a multidisciplinary team-based quality improvement approach. METHODS:A unique program called the Small Baby Unit (SBU) was established in a children's hospital to care for the ELBW infant born at 28 weeks or less and weighing less than 1000 g at birth. These patients were cared for in a separate location from the main neonatal unit. A core multidisciplinary team that participates in ongoing educational and process-improvement collaboration provides care. Evidence-based guidelines and checklists standardized the approach.RESULTS: Data from the 2 years before and 4 years after opening the SBU are included. There was a reduction in chronic lung disease from 47.5% to 35.4% (P = .097). The rate of hospital-acquired infection decreased from 39.3% to 19.4% (P , .001). Infants being discharged with growth restriction (combined weight and head circumference ,10th percentile) decreased from 62.3% to 37.3% (P = .001). Reduced resource utilization was demonstrated as the mean number per patient of laboratory tests decreased from 224 to 82 (P , .001) and radiographs decreased from 45 to 22 (P , .001).CONCLUSIONS: Care in a distinct unit by a consistent multidisciplinary SBU team using quality improvement methods improved outcomes in ELBW infants. Ongoing team engagement and development are required to sustain improved outcomes.Progress in the care of preterm newborns has gradually moved from what we do (new medications and devices) to how we do it. Although the survival rate of extremely low birth weight (ELBW) infants has improved with advances in neonatal intensive care, many survivors are discharged from the hospital with neurodevelopmental delays and/or chronic medical problems. 1 Significant variation in outcomes among NICUs has been documented. [2][3][4] Practice variation among providers at the same institution also complicates care. 5,6 Collaborative quality improvement (QI) and team-based care has been shown to significantly improve outcomes. [7][8][9][10] Outcomes for the ELBW population in the study NICU demonstrated average performance compared with national benchmarks. We hypothesized that we could improve outcomes including a reduction in chronic lung disease (CLD), a major ELBW morbidity, with a QI initiative that changed our practice model by establishing a separate unit and specialized team to care for these infants. We further hypothesized that

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Reduction in the Incidence of Chronic Lung Disease in Very Low Birth Weight Infants: Results of a Quality Improvement Process in a Tertiary Level Neonatal Intensive Care Unit

Cited by 70 publications

References 31 publications

Impact and Challenges of Early Continuous Positive Airway Pressure Therapy for Very Low Birth Weight Neonates in a Developing Country

Impact and Challenges of Early Continuous Positive Airway Pressure Therapy for Very Low Birth Weight Neonates in a Developing Country

Bubble Nasal CPAP, Early Surfactant Treatment, and Rapid Extubation Are Associated With Decreased Incidence of Bronchopulmonary Dysplasia in Very-Low-Birth-Weight Newborns: Efficacy and Safety Considerations

Small Baby Unit Improves Quality and Outcomes in Extremely Low Birth Weight Infants

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