title: Reduction in the incidence of chronic lung disease in very low birth weight infants: results of a quality improvement process in a tertiary level neonatal intensive care unit.
abstract: OBJECTIVE
  Our objective was to reduce the incidence of chronic lung disease by introducing potentially better practices in our delivery room and NICU.
  
  
  METHODS
  We compared the incidences of chronic lung disease in infants with birth weights of 501 to 1500 g in 2002 and 2005, after implementation of the changes. Medical records for infants of 501 to 1500 g who were born in 2002 and 2005 were reviewed for maternal characteristics, care of the infant in the delivery room and the NICU (including surfactant usage, duration of ventilation, duration of continuous positive airway pressure therapy, and duration of oxygen treatment), length of stay, and short-term clinical outcomes (eg, pneumothorax, severe intracranial hemorrhage, retinopathy of prematurity, and weight gain).
  
  
  RESULTS
  There was a significant reduction in our incidence of chronic lung disease, from 46.5% in 2002 to 20.5% in 2005. The number of infants discharged from the hospital with oxygen therapy also decreased significantly, from 16.4% in 2002 to 4.1% in 2005. The overall relative risk reduction for chronic lung disease in 2005, compared with 2002, was 55.8%.
  
  
  CONCLUSIONS
  By using a quality improvement process that included avoidance of intubation, adoption of new pulse oximeter limits, and early use of nasal continuous positive airway pressure therapy, we demonstrated a significant reduction in the incidence of chronic lung disease in infants with birth weights of <1500 g in 2005, in comparison with 2002. These results have persisted to date. There were no significant short-term complications.
authors.affiliation: Greater Baltimore Medical Center, Division of Neonatology, Department of Pediatrics, Baltimore, MD 21204, USA. hbirenba@gbmc.org
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Birenbaum
authors.forename: Abby
authors.initials: A
authors.lastname: Dentry
authors.forename: Jane
authors.initials: J
authors.lastname: Cirelli
authors.forename: Sabah
authors.initials: S
authors.lastname: Helou
authors.forename: Maria A
authors.initials: MA
authors.lastname: Pane
authors.forename: Karen
authors.initials: K
authors.lastname: Starr
authors.forename: Clifford F
authors.initials: CF
authors.lastname: Melick
authors.forename: Linda
authors.initials: L
authors.lastname: Updegraff
authors.forename: Cynthia
authors.initials: C
authors.lastname: Arnold
authors.forename: Angela
authors.initials: A
authors.lastname: Tamayo
authors.forename: Virma
authors.initials: V
authors.lastname: Torres
authors.forename: Norma
authors.initials: N
authors.lastname: Gungon
authors.forename: Stephen
authors.initials: S
authors.lastname: Liverman
mesh_terms: D002908:Chronic Disease; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000592:standards* / Q000639:trends; D008171:Lung Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D016896:Treatment Outcome