Quality improvement project to decrease delivery room intubations in preterm infants

Venkatakrishna Kakkilaya, Ihab Jubran, Vaishali Mashruwala, Emma Ramon, Valerie N. Simcik, Marjory Marshall, L. Steven Brown, Mambarambath A Jaleel, Vishal S Kapadia

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND AND OBJECTIVES: Avoidance of delivery room intubation (DRI) reduces death or bronchopulmonary dysplasia (BPD) in preterm neonates. Our objective with this quality improvement project was to decrease DRI rates by improving face mask positive pressure ventilation (Fm-PPV) among infants born ≤29 weeks’ gestation. METHODS: Key drivers of change were identified from a retrospective review of resuscitation records. A resuscitation bundle to optimize Fm-PPV including the use of a small round mask and end-tidal CO2 detectors, increasing peak inspiratory pressure when indicated, and debriefing after each intubation were implemented in consecutive plan-do-study-act cycles. The DRI rate was tracked by using a control chart. Resuscitation practice and outcomes of pre–quality improvement cohort (QIC) (January 2014–September 2015) were compared with post-QIC (October 2015–December 2016). RESULTS: Of the 314 infants who were resuscitated, 180 belonged to the pre-QIC and 134 to the post-QIC. The antenatal steroid administration rate was higher in the post-QIC (54% vs 88%). More infants in the post-QIC had resolution of bradycardia after Fm-PPV (56% vs 77%, P = .02). Infants in the post-QIC had lower DRI rates (58% vs 37%, P < .01), lower need for mechanical ventilation (85% vs 70%, P < .01), lower rates of BPD (26% vs 13%, P < .01), and severe retinopathy of prematurity (14% vs 5%, P = .01). Rates of DRI, BPD, and severe retinopathy of prematurity remained lower even after controlling for the potential confounders. CONCLUSIONS: Implementation of a resuscitation bundle decreased the DRI rate and improved outcomes of preterm infants.

Original languageEnglish (US)
Article numbere20180201
JournalPediatrics
Volume143
Issue number2
DOIs
StatePublished - Feb 1 2019

Fingerprint

Delivery Rooms
Quality Improvement
Intubation
Premature Infants
Masks
Resuscitation
Bronchopulmonary Dysplasia
Positive-Pressure Respiration
Retinopathy of Prematurity
Bradycardia
Artificial Respiration
Steroids
Newborn Infant
Pressure
Pregnancy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Kakkilaya, V., Jubran, I., Mashruwala, V., Ramon, E., Simcik, V. N., Marshall, M., ... Kapadia, V. S. (2019). Quality improvement project to decrease delivery room intubations in preterm infants. Pediatrics, 143(2), [e20180201]. https://doi.org/10.1542/peds.2018-0201

Quality improvement project to decrease delivery room intubations in preterm infants. / Kakkilaya, Venkatakrishna; Jubran, Ihab; Mashruwala, Vaishali; Ramon, Emma; Simcik, Valerie N.; Marshall, Marjory; Brown, L. Steven; Jaleel, Mambarambath A; Kapadia, Vishal S.

In: Pediatrics, Vol. 143, No. 2, e20180201, 01.02.2019.

Research output: Contribution to journalArticle

Kakkilaya, V, Jubran, I, Mashruwala, V, Ramon, E, Simcik, VN, Marshall, M, Brown, LS, Jaleel, MA & Kapadia, VS 2019, 'Quality improvement project to decrease delivery room intubations in preterm infants', Pediatrics, vol. 143, no. 2, e20180201. https://doi.org/10.1542/peds.2018-0201
Kakkilaya V, Jubran I, Mashruwala V, Ramon E, Simcik VN, Marshall M et al. Quality improvement project to decrease delivery room intubations in preterm infants. Pediatrics. 2019 Feb 1;143(2). e20180201. https://doi.org/10.1542/peds.2018-0201
Kakkilaya, Venkatakrishna ; Jubran, Ihab ; Mashruwala, Vaishali ; Ramon, Emma ; Simcik, Valerie N. ; Marshall, Marjory ; Brown, L. Steven ; Jaleel, Mambarambath A ; Kapadia, Vishal S. / Quality improvement project to decrease delivery room intubations in preterm infants. In: Pediatrics. 2019 ; Vol. 143, No. 2.
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abstract = "BACKGROUND AND OBJECTIVES: Avoidance of delivery room intubation (DRI) reduces death or bronchopulmonary dysplasia (BPD) in preterm neonates. Our objective with this quality improvement project was to decrease DRI rates by improving face mask positive pressure ventilation (Fm-PPV) among infants born ≤29 weeks’ gestation. METHODS: Key drivers of change were identified from a retrospective review of resuscitation records. A resuscitation bundle to optimize Fm-PPV including the use of a small round mask and end-tidal CO2 detectors, increasing peak inspiratory pressure when indicated, and debriefing after each intubation were implemented in consecutive plan-do-study-act cycles. The DRI rate was tracked by using a control chart. Resuscitation practice and outcomes of pre–quality improvement cohort (QIC) (January 2014–September 2015) were compared with post-QIC (October 2015–December 2016). RESULTS: Of the 314 infants who were resuscitated, 180 belonged to the pre-QIC and 134 to the post-QIC. The antenatal steroid administration rate was higher in the post-QIC (54{\%} vs 88{\%}). More infants in the post-QIC had resolution of bradycardia after Fm-PPV (56{\%} vs 77{\%}, P = .02). Infants in the post-QIC had lower DRI rates (58{\%} vs 37{\%}, P < .01), lower need for mechanical ventilation (85{\%} vs 70{\%}, P < .01), lower rates of BPD (26{\%} vs 13{\%}, P < .01), and severe retinopathy of prematurity (14{\%} vs 5{\%}, P = .01). Rates of DRI, BPD, and severe retinopathy of prematurity remained lower even after controlling for the potential confounders. CONCLUSIONS: Implementation of a resuscitation bundle decreased the DRI rate and improved outcomes of preterm infants.",
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