669 - Gradual weaning of CPAP is associated with decreased incidence of chronic lung disease in Extremely premature Neonates with Gestational Age ≤ 30 weeks: A Single-Center Quality Improvement (QI) project

Poster Number: 669
Publication Number: 669.139

Ranga Prasanth Thiruvenkataramani, Michigan State University College of Human Medicine, Lansing, MI, United States; Said Omar, Michigan State University College of Human Medicine, Lansing, MI, United States; TeAnna S. Piper, Michigan State University College of Human Medicine, Williamston, MI, United States; Cheryl M. Abernathy, Sparrow Health System, Davison, MI, United States; Modupe T. Awonuga, Michigan State University College of Human Medicine, East Lansing,, MI, United States; Lalitha Gundamraj, Michigan State University College of Human Medicine, Lansing, MI, United States; Tarek Mohamed, Michigan State University College of Human Medicine, East Lansing, MI, United States; Nicholas Olomu, Michigan State University, Okemos, MI, United States; Padmani Karna, Michigan State University College of Human Medicine, Lansing, MI, United States

Background: Chronic Lung Disease (CLD) is a major cause of morbidity and mortality in preterm neonates. The incidence of CLD is stable with increasing resuscitation of micropremies. CLD is a multifactorial disease with hyperoxia, mechanical ventilation, and sepsis playing a major role in developmental arrest and alveolar simplification. The incidence of CLD in VLBW infants in VON remains at 20-40%. Consistent use of gentle or non-invasive ventilation has shown a decrease in the severity of CLD, but the timing to wean these babies off CPAP is not clearly defined with variability among neonatologists. Weaning from CPAP to High flow nasal cannula (HFNC) has shown prolonged hospitalization and increased home oxygen use

Objective: To assess the incidence and severity of CLD after implementing consistent NICU set timepoint for weaning from CPAP to room air or Gradual weaning (sprinting) if weaning to room air failed in preterm neonates with GA ≤ 32 weeks

Design/Methods: A QI project was designed in our NICU to establish a consistent set of guidelines for weaning from CPAP to room air at 32 weeks PMA and with a minimum weight of 1250 grams. If the weaning is not tolerated, the neonate is to be placed back on CPAP and weaned gradually (sprinting) after 48 hours. Sprinting is a gradual weaning off CPAP to room air with increasing frequency every day: 1 hour on day 1, then 1 hour Q12 hours, then 1 hour Q6 hours, then 2 hours Q6 hours, and 3 hours on and off for 2 days and then completely off to room air. After extensive training and education for the nursing and medical team, the QI project was implemented in 2020. Data were collected for 3 years prior (2017-2019) and after (2020-2022) implementation. Data were analyzed with t-test and Chi-Square test

Results: The implementation of sprinting guidelines was associated with significantly lower incidence and severity of CLD (25.8 % vs 10.7 %; p < 0.01) compared with the prior 3 years as shown in table-1. The ventilated babies were also weaned earlier to noninvasive ventilation by day 2-3 (p= 0.01). The need for home Oxygen at discharge was decreased after sprinting implementation, although not statistically significant but clinically significant. The data also shows a consistent decrease in CLD incidence for 3 years with a mean of 10.7% (range 6%-13.8%) after sprinting guidelines implementation even with a higher percentage of neonates with lower GA

Conclusion(s): Implementation of gentle ventilation using CPAP with consistent sprinting weaning guidelines was associated with a decrease in the incidence and severity of CLD