644 - Improving Early Non-Invasive Respiratory Support for Premature Infants, a Quality Improvement Initiative

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 644
Publication Number: 644.138

Blair Welch, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Alana Barbato, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Rebecca s. Rose, Indiana University/Riley Hospital for Children at IU Health, Indianapolis, IN, United States

Presenting Author(s)

Blair Welch, MD (she/her/hers)

Neonatology Fellow
Riley Hospital for Children at Indiana University Health
Riley Hospital for Children at Indiana University Health
Indianapolis, Indiana, United States

Background: Mechanical ventilation is a risk factor for developing bronchopulmonary dysplasia (BPD), a major cause of morbidity and mortality for preterm infants. Evidence demonstrates the safety of early non-invasive respiratory support, yet avoiding exposure to mechanical ventilation remains a challenge.

Objective: Decrease the percentage of patients born at < 32 weeks and admitted on non-invasive respiratory support who require intubation and mechanical ventilation for respiratory distress syndrome or apnea of prematurity in the first week of life (defined as NICU intubations) from 40% to 32% within 6 months of project initiation and to maintain this rate for the next 6 months.

Design/Methods: We created a quality improvement (QI) initiative aimed at decreasing NICU intubations with the global aim of decreasing BPD rates. Outcome measures included NICU intubation rates, mechanical ventilation hours, and BPD or death before discharge. Process measures included adherence to Intubation/INSURE (Intubate-Surfactant-Extubate) criteria and percentage of eligible patients who underwent INSURE procedures. Balancing measures include pneumothorax development and decompensation in the first week of life. We created a key driver diagram to guide interventions (Figure 1). Data were obtained via the electronic medical record; measures were evaluated monthly and reviewed at bi-monthly multi-disciplinary meetings.

Results: There were 106 patients born at < 32 weeks admitted on non-invasive respiratory support since the project began. 25% of patients required NICU intubations, compared to 40% in the baseline period (Figure 2). While we met special cause criteria with 12 out of 14 points above the center line, we plan to wait to move the center line until additional criteria are met and improvements are sustained. Median ventilator hours have decreased since the project began, but variability still exists between patients each month (Figure 3). Use of the INSURE procedure for eligible patients increased to 57% from 8% in the baseline period. There have been no increases in balancing measures since the project began. The rate of BPD or death for those born at < 32 weeks and admitted on non-invasive support has been stable at approximately 42%. While there is not enough data to demonstrate special cause variation, the current rate of BPD or death for the subgroup of patients born at >28 weeks is 19% compared to 27% in the baseline period.

Conclusion(s): Following creation of a QI project, the percentage of patients requiring NICU intubations and the median ventilator hours in the first week of life have decreased.