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

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

Research output: Contribution to journalArticle

Abstract

OBJECTIVE. Our objective was to reduce the incidence of chronic lung disease by introducing potentially better practices in our delivery room and NICU. METHODS. We compared the incidences of chronic lung disease in infants with birth weights of 501 to 1500 g in 2002 and 2005, after implementation of the changes. Medical records for infants of 501 to 1500 g who were born in 2002 and 2005 were reviewed for maternal characteristics, care of the infant in the delivery room and the NICU (including surfactant usage, duration of ventilation, duration of continuous positive airway pressure therapy, and duration of oxygen treatment), length of stay, and short-term clinical outcomes (eg, pneumothorax, severe intracranial hemorrhage, retinopathy of prematurity, and weight gain). RESULTS. There was a significant reduction in our incidence of chronic lung disease, from 46.5% in 2002 to 20.5% in 2005. The number of infants discharged from the hospital with oxygen therapy also decreased significantly, from 16.4% in 2002 to 4.1% in 2005. The overall relative risk reduction for chronic lung disease in 2005, compared with 2002, was 55.8%. CONCLUSIONS. By using a quality improvement process that included avoidance of intubation, adoption of new pulse oximeter limits, and early use of nasal continuous positive airway pressure therapy, we demonstrated a significant reduction in the incidence of chronic lung disease in infants with birth weights of <1500 g in 2005, in comparison with 2002. These results have persisted to date. There were no significant short-term complications.

Original languageEnglish (US)
Pages (from-to)44-50
Number of pages7
JournalPediatrics
Volume123
Issue number1
DOIs
StatePublished - Jan 1 2009
Externally publishedYes

Fingerprint

Very Low Birth Weight Infant
Neonatal Intensive Care Units
Quality Improvement
Lung Diseases
Chronic Disease
Incidence
Delivery Rooms
Continuous Positive Airway Pressure
Birth Weight
Oxygen
Infant Care
Retinopathy of Prematurity
Intracranial Hemorrhages
Pneumothorax
Risk Reduction Behavior
Therapeutics
Intubation
Surface-Active Agents
Weight Gain
Medical Records

Keywords

  • Chronic lung disease
  • Nasal continuous positive airway pressure therapy
  • Quality improvement
  • Very low birth weight

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

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

In: Pediatrics, Vol. 123, No. 1, 01.01.2009, p. 44-50.

Research output: Contribution to journalArticle

Birenbaum, H, Dentry, A, Cirelli, J, Helou, S, Pane, MA, Starr, K, Melick, CF, Updegraff, L, Arnold, C, Tamayo, A, Torres, V, Gungon, N & Liverman, S 2009, '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', Pediatrics, vol. 123, no. 1, pp. 44-50. https://doi.org/10.1542/peds.2007-2872
Birenbaum, Howard ; Dentry, Abby ; Cirelli, Jane ; Helou, Sabah ; Pane, Maria A. ; Starr, Karen ; Melick, Clifford F. ; Updegraff, Linda ; Arnold, Cynthia ; Tamayo, Angela ; Torres, Virma ; Gungon, Norma ; Liverman, Stephen. / 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. In: Pediatrics. 2009 ; Vol. 123, No. 1. pp. 44-50.
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abstract = "OBJECTIVE. Our objective was to reduce the incidence of chronic lung disease by introducing potentially better practices in our delivery room and NICU. METHODS. We compared the incidences of chronic lung disease in infants with birth weights of 501 to 1500 g in 2002 and 2005, after implementation of the changes. Medical records for infants of 501 to 1500 g who were born in 2002 and 2005 were reviewed for maternal characteristics, care of the infant in the delivery room and the NICU (including surfactant usage, duration of ventilation, duration of continuous positive airway pressure therapy, and duration of oxygen treatment), length of stay, and short-term clinical outcomes (eg, pneumothorax, severe intracranial hemorrhage, retinopathy of prematurity, and weight gain). RESULTS. There was a significant reduction in our incidence of chronic lung disease, from 46.5{\%} in 2002 to 20.5{\%} in 2005. The number of infants discharged from the hospital with oxygen therapy also decreased significantly, from 16.4{\%} in 2002 to 4.1{\%} in 2005. The overall relative risk reduction for chronic lung disease in 2005, compared with 2002, was 55.8{\%}. CONCLUSIONS. By using a quality improvement process that included avoidance of intubation, adoption of new pulse oximeter limits, and early use of nasal continuous positive airway pressure therapy, we demonstrated a significant reduction in the incidence of chronic lung disease in infants with birth weights of <1500 g in 2005, in comparison with 2002. These results have persisted to date. There were no significant short-term complications.",
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AU - Pane, Maria A.

AU - Starr, Karen

AU - Melick, Clifford F.

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N2 - OBJECTIVE. Our objective was to reduce the incidence of chronic lung disease by introducing potentially better practices in our delivery room and NICU. METHODS. We compared the incidences of chronic lung disease in infants with birth weights of 501 to 1500 g in 2002 and 2005, after implementation of the changes. Medical records for infants of 501 to 1500 g who were born in 2002 and 2005 were reviewed for maternal characteristics, care of the infant in the delivery room and the NICU (including surfactant usage, duration of ventilation, duration of continuous positive airway pressure therapy, and duration of oxygen treatment), length of stay, and short-term clinical outcomes (eg, pneumothorax, severe intracranial hemorrhage, retinopathy of prematurity, and weight gain). RESULTS. There was a significant reduction in our incidence of chronic lung disease, from 46.5% in 2002 to 20.5% in 2005. The number of infants discharged from the hospital with oxygen therapy also decreased significantly, from 16.4% in 2002 to 4.1% in 2005. The overall relative risk reduction for chronic lung disease in 2005, compared with 2002, was 55.8%. CONCLUSIONS. By using a quality improvement process that included avoidance of intubation, adoption of new pulse oximeter limits, and early use of nasal continuous positive airway pressure therapy, we demonstrated a significant reduction in the incidence of chronic lung disease in infants with birth weights of <1500 g in 2005, in comparison with 2002. These results have persisted to date. There were no significant short-term complications.

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