448 - Improving Outcomes Following Initiation of Multidisciplinary Severe BPD Team

Poster Number: 448
Publication Number: 448.431

Sandra Wai, UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States; Genevieve Kinsey, UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States; Leslie A. Lusk, UCSF Benioff Children's Hospital Oakland, Alameda, CA, United States

Background: Extremely low birthweight (ELBW) infants are at high risk for bronchopulmonary dysplasia (BPD). Infants with severe BPD (SBPD) also are at risk for pulmonary hypertension (PH), retinopathy of prematurity (ROP), and death. It has been observed that optimizing respiratory and nutritional support for SBPD infants in integrated guidelines-based programs decreases the incidence of additional complications and death.

Objective: We hypothesize that outcomes of infants with severe BPD were improved with the initiation of a multidisciplinary SBPD team focused on developing and adhering to best practice guidelines, maintaining continuity of care, and facilitating multidisciplinary communication.

Design/Methods: We performed a retrospective review of all infants born < 32 weeks’ gestation who required invasive ventilation or high noninvasive support ( >4L HFNC, CPAP, NIPPV) at 36 weeks postmenstrual age, born during 2015-2021 at our institution. We compared outcomes, including ROP requiring intervention (laser or Avastin), PH requiring treatment (iNO, sildenafil, or bosentan), and death before and after initiation of our multidisciplinary SBPD team in January 2019.
 

Results: There was no significant difference between infant characteristics such as gestational age at birth (25.4 versus 26.0 weeks), birth weight (761g versus 801g), or sex (65% versus 67% male) before and after intervention (37 versus 33 infants). Despite more aggressive respiratory support aimed at SBPD physiology and clinical respiratory stability, there were lower rates of ROP requiring intervention (38% versus 9%, p=0.005). There was a significant improvement in PH screening compliance (63% versus 100%, p< 0.001). Before universal PH screening as part of the multidisciplinary management paradigm, 25% of infants had PH requiring treatment. Since the initiation of our SBPD team, there has been a stepwise reduction in the proportion of patients with PH requiring treatment (43%, 8%, and 0% annually, p=0.03). There was no difference in death (3% versus 6%, p=0.5).Conclusion(s): Initiation of a multidisciplinary guidelines-based SBPD team was associated with a decreased incidence of severe ROP requiring treatment, improved PH screening, and a decreased incidence of severe PH requiring treatment.