Sujith Kumar Reddy Gurram Venkata1, Ankur Srivastava1, Prashanth Murthy1, James N Scott2, Hussein Zein1, Lara Leijser1, Anirban Ghosh1, Sarfaraz Momin1, Sumesh Thomas1, Khorshid Mohammad3. 1. Section of Neonatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Room B4-286, 28 Oki drive NW, Calgary, AB, T3B 6A8, Canada. 2. Department of Diagnostic Imaging and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. 3. Section of Neonatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Room B4-286, 28 Oki drive NW, Calgary, AB, T3B 6A8, Canada. Khorshid.mohammad@ahs.ca.
Abstract
BACKGROUND: We evaluated the effect of the quality improvement (QI) bundle on the rate of inotrope use and associated morbidities. METHODS: We included inborn preterm neonates born at < 29 weeks admitted to level III NICU. We implemented a QI bundle focusing on the first 72 h from birth which included delayed cord clamping, avoidance of routine echocardiography, the addition of clinical criteria to the definition of hypotension, factoring iatrogenic causes of hypotension, and standardization of respiratory management. The rate of inotropes use was compared before and after implementing the care bundle. Incidence of cystic periventricular leukomalacia (cPVL) was used as a balancing measure. RESULTS: QI bundle implementation was associated with significant reduction in overall use of inotropes (24 vs 7%, p < 0.001), dopamine (18 vs 5%, p < 0.001), and dobutamine (17 vs 4%, p < 0.001). Rate of acute brain injury decreased significantly: acute brain injury of any grade (34 vs 20%, p < 0.001) and severe brain injury (15 vs 6%, p < 0.001). There was no difference in the incidence of cPVL (0.8 vs 1.4%, p = 0.66). Associations remained significant after adjusting for confounding factors. CONCLUSIONS: A quality improvement bundled approach resulted in a reduction in inotropes use and associated brain morbidities in premature babies.
BACKGROUND: We evaluated the effect of the quality improvement (QI) bundle on the rate of inotrope use and associated morbidities. METHODS: We included inborn preterm neonates born at < 29 weeks admitted to level III NICU. We implemented a QI bundle focusing on the first 72 h from birth which included delayed cord clamping, avoidance of routine echocardiography, the addition of clinical criteria to the definition of hypotension, factoring iatrogenic causes of hypotension, and standardization of respiratory management. The rate of inotropes use was compared before and after implementing the care bundle. Incidence of cystic periventricular leukomalacia (cPVL) was used as a balancing measure. RESULTS: QI bundle implementation was associated with significant reduction in overall use of inotropes (24 vs 7%, p < 0.001), dopamine (18 vs 5%, p < 0.001), and dobutamine (17 vs 4%, p < 0.001). Rate of acute brain injury decreased significantly: acute brain injury of any grade (34 vs 20%, p < 0.001) and severe brain injury (15 vs 6%, p < 0.001). There was no difference in the incidence of cPVL (0.8 vs 1.4%, p = 0.66). Associations remained significant after adjusting for confounding factors. CONCLUSIONS: A quality improvement bundled approach resulted in a reduction in inotropes use and associated brain morbidities in premature babies.
Authors: Beau Batton; Lei Li; Nancy S Newman; Abhik Das; Kristi L Watterberg; Bradley A Yoder; Roger G Faix; Matthew M Laughon; Barbara J Stoll; Krisa P Van Meurs; Waldemar A Carlo; Brenda B Poindexter; Edward F Bell; Pablo J Sánchez; Richard A Ehrenkranz; Ronald N Goldberg; Abbot R Laptook; Kathleen A Kennedy; Ivan D Frantz; Seetha Shankaran; Kurt Schibler; Rosemary D Higgins; Michele C Walsh Journal: Pediatrics Date: 2013-05-06 Impact factor: 7.124
Authors: Jonathan M Fanaroff; Deanne E Wilson-Costello; Nancy S Newman; Michelle M Montpetite; Avroy A Fanaroff Journal: Pediatrics Date: 2006-04 Impact factor: 7.124
Authors: Beau Batton; Lei Li; Nancy S Newman; Abhik Das; Kristi L Watterberg; Bradley A Yoder; Roger G Faix; Matthew M Laughon; Barbara J Stoll; Rosemary D Higgins; Michele C Walsh Journal: Arch Dis Child Fetal Neonatal Ed Date: 2015-11-13 Impact factor: 5.747
Authors: B Batton; L Li; N S Newman; A Das; K L Watterberg; B A Yoder; R G Faix; M M Laughon; B J Stoll; R D Higgins; M C Walsh Journal: J Perinatol Date: 2014-02-06 Impact factor: 2.521