WIP 22 - Implementation of a Respiratory Care Bundle to Reduce Bronchopulmonary Dysplasia in Preterm Infants at a Level 4 NICU

Publication Number: WIP 22.7449

Hyo-Jung Choi, UCLA Mattel Childrens Hospital, Los Angeles, CA, United States; Megan E. Pudlo, UCLA Mattel Childrens Hospital, Santa Monica, CA, United States; Meena Garg, UCLA Mattel Childrens Hospital, Los Angeles, CA, United States; Jane Ryu, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States; Suhas Kallapur, UCLA Mattel Childrens Hospital, Los Angeles, CA, United States

Background: Bronchopulmonary Dysplasia (BPD) is a multifactorial disease arising from the exposure of immature lungs to oxygen and mechanical ventilation, which leads to impaired alveolar and pulmonary vascular development. Despite advances in neonatal care, the incidence of BPD has remained unchanged.

Objective: This quality improvement (QI) project aimed to develop a comprehensive respiratory care guideline for premature infants born at < 32 weeks gestational age (GA). The SMART aim was to reduce the rates of grade 2 and 3 BPD from 50% to 20% by April 2025.

Design/Methods: A multidisciplinary QI team was formed to identify the key drivers, evidence-based interventions, and gather baseline data prior to implementation. A respiratory care guideline was created and included delivery room CPAP, early selective surfactant and caffeine administration, use of neurally adjusted ventilatory assist (NAVA), weaning protocols for timely extubation, optimal postnatal steroid regimens, CPAP use until 32 weeks gestation, and the introduction of Less Invasive Surfactant Administration (LISA). Small baby care guidelines, including a standardized admission order set in the electronic medical record (EMR), were also developed to optimize care and minimize morbidities for premature infants at highest risk for BPD. Additionally, a custom BPD dashboard was developed that incorporated real-time data acquired through the EMR. The outcome measure was the percentage of infants with BPD. Process measures included time to surfactant administration, duration of mechanical ventilation, and extubation failure rates. Balancing measures involved monitoring poor weight gain and postnatal steroid use. Statistical Process Control (SPC) charts were used for data analysis when applicable.

Interventions were implemented from January to December 2023 using Plan-Do-Study-Act (PDSA) cycles. We plan to analyze data from January 2023 to December 2024 to assess our adherence to our guideline, compare BPD rates to our control group, and hold stakeholder meetings to improve upon our intervention.