Reduction of bronchopulmonary dysplasia after participation in the Breathsavers Group of the Vermont Oxford Network Neonatal Intensive Care Quality Improvement Collaborative.
OBJECTIVE
The objective of this study was to compare the primary and secondary outcomes of very low birth weight infants before and after participation in the Breathsavers Group of the Vermont Oxford Network-sponsored Neonatal Intensive Care Quality Collaborative.


METHODS
Hospitals that participated in the Breathsavers Group contributed clinical data on the outcomes of their very low birth weight infants to the Vermont Oxford Network using standardized clinical definitions, data forms, and inclusion criteria. Outcomes from the last year of the collaborative, 2003, were compared with those from the baseline year, 2001. Models for treatment practices and outcomes measures were adjusted for within-hospital correlation (clustering) and standard risk factors that were present at birth.


RESULTS
Bronchopulmonary dysplasia dropped significantly in 2003 compared with the baseline year. Survival improved but not significantly. In addition, severe retinopathy of prematurity, severe intraventricular hemorrhage, and supplemental oxygen at discharge dropped significantly. The use of conventional ventilation at any time during the initial hospitalization, postnatal steroids, and time to first dose of surfactant all decreased significantly. The use of nasal continuous positive airway pressure at any time during hospitalization increased. The use of high-frequency ventilation, delivery room intubation, and surfactant at any time during hospitalization did not change.


CONCLUSIONS
The Breathsavers Group improved both clinical care processes and clinical outcomes during the Neonatal Intensive Care Quality Collaborative.
Payne
Nathaniel R
NR
Division of Neonatology, Children's Hospitals and Clinics, 2525 Chicago Ave South, Minneapolis, MN, USA. rob.payne@childrensmn.org
LaCorte
Meena
M
Karna
Padmani
P
Chen
Song
S
Finkelstein
Marsha
M
Goldsmith
Jay P
JP
Carpenter
Joseph H
JH
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology / Q000517:prevention & control*; D002543:Cerebral Hemorrhage / Q000453:epidemiology; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D015931:Intensive Care, Neonatal / Q000592:standards*; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010102:Oxygen Inhalation Therapy / Q000706:statistics & numerical data; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D011785:Quality Assurance, Health Care; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012178:Retinopathy of Prematurity / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
D000305:Adrenal Cortex Hormones; D011663:Pulmonary Surfactants