5: Impact of Open Lung Strategy on the Neonatal Outcomes in Preterm Infants. Issue 6 (1st June 2014)

• Record Type: Journal Article
• Authors: Nair, V; Soraisham, A; Yee, W; Singhal, N
• Is Part Of: Paediatrics & Child Health. Volume 19:Issue 6(2014)
• Page Start: e37
• Page End: e37
• Publication Date: 2014-06-01
• Subjects: Pediatrics -- Periodicals; Children -- Health and hygiene -- Periodicals; 618.92
• DOI: 10.1093/pch/19.6.e35-5
• Languages: English
• ISSNs: 1205-7088

Abstract

Abstract: BACKGROUND: Our aim was to reduce bronchopulmonary dysplasia (BPD) at Foothills Medical Center (FMC), which had one of the highest rates among Canadian NICUs. We developed evidence-based practice guidelines called Open Lung Strategy (OLS), to help maintain functional residual capacity with distending pressures. OBJECTIVES: To examine the impact of 'open lung strategy' on short term neonatal outcomes among preterm infants with gestational age <33 weeks. DESIGN/METHODS: This is retrospective cohort study. In October 2011, OLS was implemented through multidisciplinary meeting, use of checklist and quarterly feedback to the neonatal group. We included all infants with gestational age <33 weeks. The pre-OLS group included infants admitted between July 2010 and Sept 2011 and the post-OLS group were those admitted between Oct 2011 to Dec 2012. Neonatal outcomes between the two groups were analyzed using univariate and multivariate analysis. The primary outcome was bronchopulmonary dysplasia (BPD) at 36 weeks postmenstrual age. Secondary outcomes included intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP) and necrotizing enterocolitis (NEC). RESULTS: Of the 792 eligible infants, 396 were admitted in post OLS study period. No significant differences were observed in the baseline characteristics between the two groups. On univariate analysis, BPD and ROP ≥ stage3 was significantly reduced in post OLS group. However, IVH was significantly increased in the Post OLS group. CONCLUSIONS: The implementation of a practice change targeting a respiratory management strategy resulted in reduced rates of BPD. There was an associated decrease in ROP and increase in IVH the secondary outcomes. A longer period of study will determine if the improvement in BPD and ROP is sustained and if the change in IVH is a true increase. When quality improvement strategies are implemented comprehensive disease free survival should be studied.