PEDIATRICS Vol. 118 Supplement November 2006, pp. S73-S77 (doi:10.1542/peds.2006-0913C)
ARTICLE |
Reduction of Bronchopulmonary Dysplasia After Participation in the Breathsavers Group of the Vermont Oxford Network Neonatal Intensive Care Quality Improvement Collaborative
a Division of Neonatology
d Department of Clinical Care Innovation and Research, Children's Hospital and Clinics, Minneapolis, Minnesota
b Division of Neonatology, Department of Pediatrics, Interfaith Medical Center, Brooklyn, New York
c Division of Neonatology, Sparrow Hospital and Michigan State University, Lansing, Michigan
e Division of Neonatology, Department of Pediatrics, Ochsner Clinic, New Orleans, Louisiana
f Vermont Oxford Network, Burlington, Vermont
OBJECTIVE. The objective of this study was to compare the primary and secondary outcomes of very low birth weight infants before and after participation in the Breathsavers Group of the Vermont Oxford Network–sponsored Neonatal Intensive Care Quality Collaborative.
METHODS. Hospitals that participated in the Breathsavers Group contributed clinical data on the outcomes of their very low birth weight infants to the Vermont Oxford Network using standardized clinical definitions, data forms, and inclusion criteria. Outcomes from the last year of the collaborative, 2003, were compared with those from the baseline year, 2001. Models for treatment practices and outcomes measures were adjusted for within-hospital correlation (clustering) and standard risk factors that were present at birth.
RESULTS. Bronchopulmonary dysplasia dropped significantly in 2003 compared with the baseline year. Survival improved but not significantly. In addition, severe retinopathy of prematurity, severe intraventricular hemorrhage, and supplemental oxygen at discharge dropped significantly. The use of conventional ventilation at any time during the initial hospitalization, postnatal steroids, and time to first dose of surfactant all decreased significantly. The use of nasal continuous positive airway pressure at any time during hospitalization increased. The use of high-frequency ventilation, delivery room intubation, and surfactant at any time during hospitalization did not change.
CONCLUSIONS. The Breathsavers Group improved both clinical care processes and clinical outcomes during the Neonatal Intensive Care Quality Collaborative.
Key Words: bronchopulmonary dysplasia • very low birth weight infant • process improvement • NICU • quality improvement
Abbreviations: VON—Vermont Oxford Network • NIC/Q 2002—Neonatal Intensive Care Quality Improvement Collaborative 2002 • VLBW—very low birth weight • PBP—potentially better practice • BPD—bronchopulmonary dysplasia • PMA—postmenstrual age • aOR—adjusted odds ratio • CI—confidence interval • ROP—retinopathy of prematurity • SROP—severe retinopathy of prematurity • SIVH—severe intraventricular hemorrhage
Accepted Jul 18, 2006.
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