Improved Outcomes With Standardized Convalescent Preterm Respiratory Care Practices

Background: Chronic lung disease is the most common morbidity affecting very low birthweight (VLBW) infants. Many of these infants are discharged home on oxygen, placing significant emotional and financial burdens on families. We sought to reduce the proportion of VLBW infants requiring discharge home on oxygen by improving convalescent respiratory practices.

Methods: We performed a prospective quality-improvement project for infants with birth weights ≤ 1,500 g in a single neonatal ICU. Using Plan-Do-Study-Act cycles, we developed and implemented a room air challenge, oxygen reference chart, and a standardized oxygen delivery guideline. The primary outcome was the proportion of VLBW infants discharged home on oxygen. Secondary outcomes included rate of chronic lung disease and postmenstrual age when off all respiratory support. Balancing measures were postmenstrual age and weight at discharge, as well as unplanned readmissions. Statistical process control charts were used to monitor outcomes and balancing measures.

Results: The proportion of VLBW infants discharged home on oxygen decreased from 34.4% to 18.5% and 21.7% in the following two years (P = .044 and P = .01, respectively). G-Chart analysis showed a higher mean number of successes between failures. The rate of chronic lung disease decreased from 31.2% to 25.4% (P = .03). The mean postmenstrual age at discharge, mean weight at discharge, and readmission rate were unchanged.

Conclusion: Standardization of convalescent respiratory care practices improved respiratory morbidities in VLBW infants. These interventions could be utilized in other NICUs with high incidence of respiratory morbidities despite improvement in delivery room practices.