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Article

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

1
Division of Neonatology, Department of Pediatrics, Golisano Children’s Hospital, University of Rochester Medical Center, 601 Elmwood Avenue, Box 651, Rochester, NY 14642, USA
2
Department of Nursing, University of Rochester Medical Center, Rochester, NY 14642, USA
*
Author to whom correspondence should be addressed.
Academic Editor: Vineet Bhandari
Received: 15 February 2021 / Revised: 26 March 2021 / Accepted: 9 April 2021 / Published: 15 April 2021
(This article belongs to the Special Issue Neonatal Respiratory Distress)
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. View Full-Text
Keywords: quality improvement; bronchopulmonary dysplasia; chronic lung disease quality improvement; bronchopulmonary dysplasia; chronic lung disease
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MDPI and ACS Style

Dylag, A.M.; Tulloch, J.; Paul, K.E.; Meyers, J.M. A Quality Improvement Initiative to Reduce Bronchopulmonary Dysplasia in a Level 4 NICU—Golden Hour Management of Respiratory Distress Syndrome in Preterm Newborns. Children 2021, 8, 301. https://0-doi-org.brum.beds.ac.uk/10.3390/children8040301

AMA Style

Dylag AM, Tulloch J, Paul KE, Meyers JM. A Quality Improvement Initiative to Reduce Bronchopulmonary Dysplasia in a Level 4 NICU—Golden Hour Management of Respiratory Distress Syndrome in Preterm Newborns. Children. 2021; 8(4):301. https://0-doi-org.brum.beds.ac.uk/10.3390/children8040301

Chicago/Turabian Style

Dylag, Andrew M., Jamey Tulloch, Karen E. Paul, and Jeffrey M. Meyers 2021. "A Quality Improvement Initiative to Reduce Bronchopulmonary Dysplasia in a Level 4 NICU—Golden Hour Management of Respiratory Distress Syndrome in Preterm Newborns" Children 8, no. 4: 301. https://0-doi-org.brum.beds.ac.uk/10.3390/children8040301

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