Published online December 29, 2008
PEDIATRICS Vol. 123 No. 1 January 2009, pp. 44-50 (doi:10.1542/peds.2007-2872)

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Birenbaum, H. J. Articles by Liverman, S. Search for Related Content PubMed PubMed Citation Articles by Birenbaum, H. J. Articles by Liverman, S. Related Collections Premature & Newborn Social Bookmarking                         What's this?

ARTICLE

Reduction in the Incidence of Chronic Lung Disease in Very Low Birth Weight Infants: Results of a Quality Improvement Process in a Tertiary Level Neonatal Intensive Care Unit

Howard J. Birenbaum, MD^a, Abby Dentry, CRNP^a, Jane Cirelli, CRNP^a, Sabah Helou, MD^a, Maria A. Pane, MD^a, Karen Starr, CRNP^a, Clifford F. Melick, PhD^b, Linda Updegraff, CRNP^a, Cynthia Arnold, CRNP^a, Angela Tamayo, MD^a, Virma Torres, MD^a, Norma Gungon, MD^a and Stephen Liverman, MD^a

^a Department of Pediatrics, Division of Neonatology, Greater Baltimore Medical Center, Baltimore, Maryland
^b Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland

OBJECTIVE. Our objective was to reduce the incidence of chronic lung disease by introducing potentially better practices in our delivery room and NICU.

METHODS. We compared the incidences of chronic lung disease in infants with birth weights of 501 to 1500 g in 2002 and 2005, after implementation of the changes. Medical records for infants of 501 to 1500 g who were born in 2002 and 2005 were reviewed for maternal characteristics, care of the infant in the delivery room and the NICU (including surfactant usage, duration of ventilation, duration of continuous positive airway pressure therapy, and duration of oxygen treatment), length of stay, and short-term clinical outcomes (eg, pneumothorax, severe intracranial hemorrhage, retinopathy of prematurity, and weight gain).

RESULTS. There was a significant reduction in our incidence of chronic lung disease, from 46.5% in 2002 to 20.5% in 2005. The number of infants discharged from the hospital with oxygen therapy also decreased significantly, from 16.4% in 2002 to 4.1% in 2005. The overall relative risk reduction for chronic lung disease in 2005, compared with 2002, was 55.8%.

CONCLUSIONS. By using a quality improvement process that included avoidance of intubation, adoption of new pulse oximeter limits, and early use of nasal continuous positive airway pressure therapy, we demonstrated a significant reduction in the incidence of chronic lung disease in infants with birth weights of <1500 g in 2005, in comparison with 2002. These results have persisted to date. There were no significant short-term complications.

---

Key Words: chronic lung disease • very low birth weight • nasal continuous positive airway pressure therapy • quality improvement

Abbreviations: CLD—chronic lung disease • PEEP—positive end-expiratory pressure • CPAP—continuous positive airway pressure

---

Accepted Apr 2, 2008.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				H. Aly Ventilation Without Tracheal Intubation Pediatrics, August 1, 2009; 124(2): 786 - 789. [Full Text] [PDF]