Chronic lung disease in very low birth weight infants: Persistence and improvement of a quality improvement process in a tertiary level neonatal intensive care unit

Article type: Research Article

Authors: Birenbaum, H.J.^{a; *} | Pfoh, E.R.^b | Helou, S.^a | Pane, M.A.^a | Marinkovich, G.A.^a | Dentry, A.^a | Yeh, Hsin-Chieh^b | Updegraff, L.^a | Arnold, C.^a | Liverman, S.^a | Cawman, H.^a

Affiliations: [a] Division of Neonatology, Department of Pediatrics, Greater Baltimore Medical Center, Baltimore, MD, USA | [b] Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA

Correspondence: [*] Address for correspondence: Howard J. Birenbaum, M.D., Division of Neonatology, Department of Pediatrics, Greater Baltimore Medical Center, 6701 North Charles Street, Baltimore, Maryland 21204, USA. Tel.: +443 849 2792; Fax: +1 443 849 2977; E-mail: hbirenba@gbmc.org.

Abstract: OBJECTIVE: We previously demonstrated a significant reduction in our incidence of chronic lung disease in our NICU using potentially better practices of avoiding delivery room endotracheal intubation and using early nasal CPAP. We sought to demonstrate whether these improvements were sustained and or improved over time. STUDY DESIGN: We conducted a retrospective, cross-sectional analysis of infants 501–1500 grams born at our hospital between 2005 and 2013. Infants born during the 2005–2007, 2008–2010 and 2011–2013 epochs were grouped together, respectively. Descriptive analysis was conducted to determine the number and percent of maternal and neonatal characteristics by year grouping. Chi-squared tests were used to determine whether there were any statistically significant changes in characteristics across year groupings.. Two outcome variables were assessed: a diagnosis of chronic lung disease based on the Vermont Oxford Network definition and being discharged home on supplemental oxygen. RESULTS: There was a statistically significant improvement in the incidence of chronic lung disease in infants below 27 weeks’ gestation in the three year period in the 2011–2013 cohort compared with those in the 2005–2007 cohort. We also found a statistically significant improvement in the number of infants discharged on home oxygen with birth weights 751–1000 grams and infants with gestational age less than 27 weeks in the 2011–2013 cohort compared to the 2005–2007 cohort. CONCLUSIONS: We demonstrated sustained improvement in our incidence of CLD between 2005 and 2013. We speculate that a multifaceted strategy of avoiding intubation and excessive oxygen in the delivery room, the early use of CPAP, as well as the use of volume targeted ventilation, when needed, may help significantly reduce the incidence of CLD.

Keywords: Chronic lung disease, very low birth weight, nasal CPAP, quality improvement, persistence

DOI: 10.3233/NPM-16915098

Journal: Journal of Neonatal-Perinatal Medicine, vol. 9, no. 2, pp. 187-194, 2016