Evaluation and Development of Potentially Better Practices to Reduce Bronchopulmonary Dysplasia in Very Low Birth Weight Infants

Payne, Nathaniel R.; LaCorte, Meena; Sun, Shyan; Karna, Padmani; Lewis-Hunstiger, Martha; Goldsmith, Jay P.

doi:10.1542/peds.2006-0913b

Cited by 40 publications

(21 citation statements)

References 63 publications

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“…4,5,7,8,14,33,34 The 100 000 Babies Campaign was unique in that it was successfully conducted within a large neonatal network with automated data collection, and improved multiple processes and outcomes simultaneously, rather than targeting a single process or morbidity.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Multifaceted Approach to Improving Outcomes in the NICU: The Pediatrix 100 000 Babies Campaign

Ellsbury¹,

Clark²,

Ursprung³

et al. 2016

Pediatrics

115

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BACKGROUND AND OBJECTIVE: Despite advances in neonatal medicine, infants requiring neonatal intensive care continue to experience substantial morbidity and mortality. The purpose of this initiative was to generate large-scale simultaneous improvements in multiple domains of care in a large neonatal network through a program called the “100,000 Babies Campaign.” METHODS: Key drivers of neonatal morbidity and mortality were identified. A system for retrospective morbidity and mortality review was used to identify problem areas for project prioritization. NICU system analysis and staff surveys were used to facilitate reengineering of NICU systems in 5 key driver areas. Electronic health record–based automated data collection and reporting were used. A quality improvement infrastructure using the Kotter organizational change model was developed to support the program. RESULTS: From 2007 to 2013, data on 422 877 infants, including a subset with birth weight of 501 to 1500 g (n = 58 555) were analyzed. Key driver processes (human milk feeding, medication use, ventilator days, admission temperature) all improved (P < .0001). Mortality, necrotizing enterocolitis, retinopathy of prematurity, bacteremia after 3 days of life, and catheter-associated infection decreased. Survival without significant morbidity (necrotizing enterocolitis, severe intraventricular hemorrhage, severe retinopathy of prematurity, oxygen use at 36 weeks’ gestation) improved. CONCLUSIONS: Implementation of a multifaceted quality improvement program that incorporated organizational change theory and automated electronic health record–based data collection and reporting program resulted in major simultaneous improvements in key neonatal processes and outcomes.

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Section: Discussionmentioning

confidence: 99%

“…10 Emphasis was placed on identifying clinical processes that were modifiable and had substantial impact on the primary drivers of poor health outcomes 8,[11][12][13][14][15][16][17][18][19][20] (Fig 1). John Kotter's 8-step model for leading organizational change was used for the design and implementation of our campaign (Fig 2).…”

Section: Model Developmentmentioning

confidence: 99%

A Multifaceted Approach to Improving Outcomes in the NICU: The Pediatrix 100 000 Babies Campaign

Ellsbury¹,

Clark²,

Ursprung³

et al. 2016

Pediatrics

115

View full text Add to dashboard Cite

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“…Variability in the incidence of BPD has been well illustrated by data from the Vermont Oxford Network but published reports are based on data from individual institutions [9] . An analysis of the rate of BPD obtained from representative population-based European cohorts has not yet been described.…”

Section: Introductionmentioning

confidence: 99%

Rates of Bronchopulmonary Dysplasia in Very Preterm Neonates in Europe: Results from the MOSAIC Cohort

Gortner

Misselwitz²,

Milligan³

et al. 2010

Neonatology

117

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Background: A considerable local variability in the rate of bronchopulmonary dysplasia (BPD) has been recorded previously. Objectives: The objectives of the present study were to describe regional differences in the rate of BPD in very preterm neonates from a European population-based cohort and to further delineate risk factors. Methods: 4,185 survivors to 36 weeks’ postmenstrual age of 4,984 live-born infants born at 24+0–31+6 weeks’ gestation in 2003 (the MOSAIC cohort) in 10 European regions were enrolled using predefined structured questionnaires. Results: Overall median gestational age of preterms without BPD was 30 weeks (range 23–31), median birth weight 1,320 g (range 490–3,150) compared with 27 weeks (23–31) and 900 g (370–2,460) in those with BPD. The region-specific crude rate of BPD ranged from 10.2% (Italian region) to 24.8% (UK Northern region). Maternal hypertension, immaturity, male gender, small for gestational age, Apgar <7 and region of care were associated with an increased incidence of BPD on multivariate analysis. Conclusion: A wide variability of BPD between European regions may be explained by different local practices; the strongest association however was with degree of immaturity.

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“…37 In addition, data from the Vermont Oxford Network indicate that the incidences of ROP and bronchopulmonary dysplasia are lower when a lower oxygen saturation range is targeted. 38 However, because these were observational studies, no cause-andeffect relationship can be inferred.…”

Section: Randomized Clinical Trials Of Oxygen Targetingmentioning

confidence: 99%

Oxygen Targeting in Extremely Low Birth Weight Infants

Cummings¹,

Polin²,

Newborn³

2016

Pediatrics

Self Cite

114

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The use of supplemental oxygen plays a vital role in the care of the critically ill preterm infant, but the unrestricted use of oxygen can lead to unintended harms, such as chronic lung disease and retinopathy of prematurity. An overly restricted use of supplemental oxygen may have adverse effects as well. Ideally, continuous monitoring of tissue and cellular oxygen delivery would allow clinicians to better titrate the use of supplemental oxygen, but such monitoring is not currently feasible in the clinical setting. The introduction of pulse oximetry has greatly aided the clinician by providing a relatively easy and continuous estimate of arterial oxygen saturation, but pulse oximetry has several practical, technical, and physiologic limitations. Recent randomized clinical trials comparing different pulse oximetry targets have been conducted to better inform the practice of supplemental oxygen use. This clinical report discusses the benefits and limitations of pulse oximetry for assessing oxygenation, summarizes randomized clinical trials of oxygen saturation targeting, and addresses implications for practice.

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Evaluation and Development of Potentially Better Practices to Reduce Bronchopulmonary Dysplasia in Very Low Birth Weight Infants

Cited by 40 publications

References 63 publications

A Multifaceted Approach to Improving Outcomes in the NICU: The Pediatrix 100 000 Babies Campaign

A Multifaceted Approach to Improving Outcomes in the NICU: The Pediatrix 100 000 Babies Campaign

Rates of Bronchopulmonary Dysplasia in Very Preterm Neonates in Europe: Results from the MOSAIC Cohort

Oxygen Targeting in Extremely Low Birth Weight Infants

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