378 - Improving Early Non-Invasive Respiratory Support of Preterm Infants: A Quality Improvement Initiative

Poster Number: 378
Publication Number: 378.434

Blair Welch, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Alana L. Barbato, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Meghan Drayton Jackson, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Izlin Lien, Indiana University School of Medicine, Indianapolis, IN, United States; Rebecca S. Rose, Indiana University/Riley Hospital for Children at IU Health, Indianapolis, IN, United States

Background: Early respiratory management for premature infants significantly impacts morbidity and mortality. Evidence demonstrates the benefits of initial non-invasive ventilation, but avoiding intubation remains a challenge.

Objective: We aimed to decrease the percentage of infants initially managed on non-invasive support who require intubation for either respiratory distress syndrome or apnea of prematurity in the first week of life from 40% to 32% within 6 months of project initiation.

Design/Methods: We developed a quality improvement initiative aimed at decreasing intubations in the first week of life for < 32wk infants initially managed on non-invasive respiratory support with the global aim of decreasing the BPD rates in this population. We tracked process measures, including number of INSURE (Intubate-Surfactant-Extubate) attempts, average number of hours spent on mechanical ventilation, and balancing measures, such as development of a pneumothorax on non-invasive support, and decompensation in the first week of life. Initial interventions included unit-wide project education, creation of criteria for standard intubation and/or INSURE, and recommendations for troubleshooting worsening respiratory status. Using data obtained from the electronic medical record we evaluated measures monthly, with bi-monthly multi-disciplinary meetings to review results and design future PDSA cycles.

Results: Since project initiation in August 2021, there have been 56 infants born at < 32 weeks gestation. Although there are too few data points to demonstrate special cause, less of these infants have required intubation in the first week of life for respiratory etiologies (see Figure 1). Stratifying by infants born at >28 weeks gestation, only one infant has required mechanical ventilation in the first week of life compared to an average of 21% prior to the project. Similarly, the average number of hours with mechanical ventilation exposure in the first week of life for infants admitted on non-invasive respiratory support appears decreased although more data is needed to show special cause variation. There were no increases in the rates of pneumothorax or decompensation in the first week of life since project initiation.Conclusion(s): Early data suggests the rates of intubations and the average number of hours spent on mechanical ventilation in the first week of life for preterm infants admitted on non-invasive respiratory support have decreased since initiation of our QI project.
Figure 1: NICU Intubations
Figure 2: Hours on Mechanical Ventilation