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

Howard Birenbaum, E. R. Pfoh, S. Helou, M. A. Pane, G. A. Marinkovich, A. Dentry, Hsin Chieh Yeh, L. Updegraff, C. Arnold, S. Liverman, H. Cawman

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)187-194
Number of pages8
JournalJournal of Neonatal-Perinatal Medicine
Volume9
Issue number2
DOIs
StatePublished - Jun 22 2016

Fingerprint

Very Low Birth Weight Infant
Neonatal Intensive Care Units
Quality Improvement
Lung Diseases
Chronic Disease
Delivery Rooms
Incidence
Oxygen
Intratracheal Intubation
Nose
Intubation
Birth Weight
Gestational Age
Ventilation
Cross-Sectional Studies
Mothers
Pregnancy

Keywords

  • Chronic lung disease
  • nasal CPAP
  • persistence
  • quality improvement
  • very low birth weight

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

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. / Birenbaum, Howard; Pfoh, E. R.; Helou, S.; Pane, M. A.; Marinkovich, G. A.; Dentry, A.; Yeh, Hsin Chieh; Updegraff, L.; Arnold, C.; Liverman, S.; Cawman, H.

In: Journal of Neonatal-Perinatal Medicine, Vol. 9, No. 2, 22.06.2016, p. 187-194.

Research output: Contribution to journalArticle

Birenbaum, Howard ; Pfoh, E. R. ; Helou, S. ; Pane, M. A. ; Marinkovich, G. A. ; Dentry, A. ; Yeh, Hsin Chieh ; Updegraff, L. ; Arnold, C. ; Liverman, S. ; Cawman, H. / 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. In: Journal of Neonatal-Perinatal Medicine. 2016 ; Vol. 9, No. 2. pp. 187-194.
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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.",
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T2 - Persistence and improvement of a quality improvement process in a tertiary level neonatal intensive care unit

AU - Birenbaum, Howard

AU - Pfoh, E. R.

AU - Helou, S.

AU - Pane, M. A.

AU - Marinkovich, G. A.

AU - Dentry, A.

AU - Yeh, Hsin Chieh

AU - Updegraff, L.

AU - Arnold, C.

AU - Liverman, S.

AU - Cawman, H.

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N2 - 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.

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