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
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
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DOI：
10.1542/peds.2007-2872
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发表时间：
2009-01-01
期刊：
影响因子：
8
通讯作者：
Liverman, Stephen
中科院分区：
文献类型：
--
作者：
Birenbaum, Howard J.;Dentry, Abby;Liverman, Stephen
目标。我们的目标是通过在我们的产房和NICU引入潜在的更好的做法来减少慢性肺部疾病的发生率。方法：我们比较了实施这些改变后，2002年和2005年出生体重在501到1500克之间的婴儿的慢性肺部疾病的发生率。回顾了2002年和2005年出生的501-1500克婴儿的母亲特征、在产房和NICU中对婴儿的护理(包括表面活性物质的使用、机械通气时间、持续气道正压治疗时间和氧气治疗时间)、住院时间和短期临床结果(如气胸、严重颅内出血、早产儿视网膜病变和体重增加)。结果：我们的慢性肺部疾病发病率显著下降，从2002年的46.5%下降到2005年的20.5%。接受氧疗的出院婴儿数量也大幅下降，从2002年的16.4%下降到2005年的4.1%。与2002年相比，2005年慢性肺部疾病的总体相对风险降低了55.8%。结论：通过使用质量改进过程，包括避免插管、采用新的脉搏血氧饱和度限值和早期使用鼻腔持续正压治疗，我们证明了出生体重为30%的婴儿慢性肺部疾病的发病率显著降低。
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