055 - Impact of Sustained CPAP >32 weeks PCA on Chronic Lung disease (CLD) among VLBW Infants at Michigan State Quality Collaborative (MICQI)

Padmani Karna, Michigan State University College of Human Medicine, E. Lansing, MI, United States; Jeannette E. Prentice, Helen DeVos Children's Hospital, Grand Rapids, MI, United States

Background: CLD remains a significant morbidity among VLBW infants. Survival of VLBW infants is increasing, especially for ELBW infants, contributing to a persistently high rate of CLD. Implementation of nCPAP is an established mode of non-invasive respiratory support for preterm infants with an extensive body of evidence supporting its clinical use. 1,2. Different strategies for weaning off nCPAP have been described and vary considerably between neonatal units. Weaning off CPAP is suggested once infants no longer require oxygen supplementation and breathe comfortably with weight of at least 1200g and post conceptional age (PCA) of 32 weeks. 3,4

Objective: Our goal was to implement sustained CPAP through at least 32 weeks PCA for VLBW infants and assess its impact on CLD at the NICUs in MICQI.

Design/Methods: Voluntary Michigan NICU collaborative (MICQI) has been trying to decrease CLD rate since 2019, initially implementing strategies of early CPAP or early extubation to CPAP rather than extended ventilator use. Strategy of weaning from CPAP only after 32 weeks PCA for VLBW infants was added in 2021 to improve CLD rate after half day seminar with Dr. Aly and team. Each center shared education and the importance of sustained CPAP with their staff. Prospective data was collected from all centers for all VLBW infants regarding PCA when CPAP was discontinued. Compliance with the weaning guidelines at each center was not reviewed. Data was shared and reviewed at regular Collaborative webinars.

Results: Our data reflects improving sustained CPAP > 32 weeks PCA after implementation in 2021 at MICQI centers. However, implementation was variable at centers and was better among ELBW infants. Collaborative Median CLD rate decreased each year from 2019 to 2022 but increased back in 2023. Nationally CLD rate has increased in 2023 as seen in Vermont Oxford Network. Nine of 16 MICQI NICUs CLD rate decreased from 2019 to 2022 but only 7 of 16 NICUs maintained lower CLD rate in 2023.

Conclusion(s): Non-invasive modes of respiratory support have provided modest success in reducing the incidence of bronchopulmonary dysplasia.5 We report first State collaborative improving CLD rate with sustained CPAP through 32 weeks PCA as one of the strategies. Further assessment is needed to evaluate the increased CLD rate in 2023. We suspect this may reflect the increased survival of ELBW infants, but review of mortality rate at centers does not completely explain the CLD rate variability. As has been previously reported, CLD among VLBW infants is a complex multifactorial condition.

VLBW % weaned < 32 weeks PCA each year at MICQI centers
10 of 16 NICUs improved CPAP weaning after sustaining CPAP > 32 weeks PCA from 2021 to 2023. Two centers did not change weaning rates, and 4 centers had an increased percentage of babies weaned off CPAP at < 32 weeks PCA

Quarterly data of CPAP weaned <32 weeks PCA since 2021 at MICQI centers
Quarterly data from 2021at MICQI centers demonstrates a progressive decrease in percent of infants weaned off CPAP prior to 32 weeks.

CLD: Infants <33 weeks, All VLBW Infants Annually by Birth year 2019-
MICQI Collaborative Median CLD rate decreased each year from 2019 to 2022 but increased in 2023. Nationally CLD rate has increased in 2023 as seen in Vermont Oxford Network