229 - The impact of the quality improvement bundle on short-term outcomes in neonates with congenital diaphragmatic hernia.

Poster Number: 229
Publication Number: 229.221

Krishan Yadav, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Mimi Kuan, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Michael Castaldo, BC Women's Hospital, Vancouver, BC, Canada; Joseph Ting, University of Alberta, Edmonton, AB, Canada; Erik Skarsgard, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Horacio Osiovich, BC Women's Hospital, Vancouver, BC, Canada; Alfonso Solimano, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Jason Tan, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Michael Traynor, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Martin Hosking, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Natalie Chan, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada

Background: Congenital diaphragmatic hernia (CDH) is associated with significant morbidity and mortality, primarily due to lung hypoplasia and pulmonary hypertension. The severity of pulmonary hypertension and cardiac dysfunction in CDH are major determinants of patient survival.

Objective: To evaluate the effect of the integration of the quality improvement (QI) bundle on short-term outcomes in neonates with CDH.

Design/Methods: This was a retrospective cohort study done during two epochs (epoch I = January 2013 – December 2017; epoch II = January 2018 – March 2021) in a quaternary neonatal intensive care unit (NICU). All infants born at gestational age ≥34 weeks and admitted to BC Women’s Hospital NICU with diagnosis of CDH based on postnatal radiographic evidence and/or antenatal scans were included in the study. Demographic and cardiorespiratory data during both epochs were analyzed. During epoch II, we introduced a QI bundle consisting of various modifications in clinical care (Table 1). Overall mortality, composite outcome of death or need of respiratory support (CPAP/NIV/tracheostomy) at discharge and individual short-term outcomes, were compared between epoch I and epoch II.

Results: A total of 57 infants met the inclusion criteria (37 during epoch I and 20 during epoch II). Baseline characteristics were similar among the infants during both epochs (Table 2). Median (IQR) ages at surgery during epoch I and epoch II were 4 (2.8 – 5) and 3.5 days (2 – 4.3) (p-value = 0.45), respectively. There was a significant decline in overall mortality among the infants with CDH during epoch II (epoch II = 0% [n=0] vs epoch I = 27% [n=10]; p-value = 0.010) (Table 3). During epoch II, duration of all inotropes was high among users (4 days vs 22.5 days; p-value =0.007) but not in the use of iNO, benzodiazepines, opioids and muscle relaxants. No differences were observed in composite outcome of mortality (all) or respiratory support on discharge and other short-term neonatal outcomes (Table 3).Conclusion(s): With the introduction of the quality improvement bundle, we demonstrated a significant reduction in overall mortality without any increase in short-term neonatal morbidities in this cohort of infants with CDH.
Krishan YadavKRISHAN YADAV-CV .pdf
Table 2. Baseline clinical and demographic characteristics of infants with CDH.