title: Impact of implementing 5 potentially better respiratory practices on neonatal outcomes and costs.
abstract: OBJECTIVE
  We implemented 5 potentially better practices to limit mechanical ventilation (MV), supplemental oxygen, and bronchopulmonary dysplasia in newborn infants born before 33 weeks' gestation.
  
  
  METHODS
  The methods used in this study included (1) exclusive use of bubble continuous positive airway pressure (bCPAP), (2) provision of bCPAP in the delivery room, (3) strict intubation criteria, (4) strict extubation criteria, and (5) prolonged CPAP to avoid supplemental oxygen. We excluded outborn infants and those with major anomalies and obstetric complications from analysis.
  
  
  RESULTS
  Demographics were similar in 61 infants born before and 60 born after implementation. For infants born at 26 to 32(6/7) weeks' gestation, intubation (first 72 hours) decreased from 52% to 11% (P < .0001) and surfactant use decreased from 48% to 14% (P=.0001). In all infants, the mean ± SD fraction of inspired oxygen requirement (first 24 hours) decreased from 0.27 ± 0.08 to 0.24 ± 0.05 (P=.0005), days of oxygen decreased from 23.5 ± 44.5 to 9.3 ± 22.0 (P=.04), and days of MV decreased from 8.8 ± 27.8 to 2.2 ± 6.2 (P=.005). Hypotension decreased from 33% to 15% (P=.03). The percentage of infants with bronchopulmonary dysplasia was 17% before and 8% after (P=.27). Nurse staffing ratios remained unchanged.
  
  
  CONCLUSIONS
  Implementation of these potentially better practices reduced the need for MV, surfactant, and supplemental oxygen as well as reduced hypotension among infants born before 33 weeks' gestation without adverse consequences. The costs for equipment and surfactant were lower.
authors.affiliation: St Elizabeth's Medical Center, Division of Newborn Medicine, 736 Cambridge St, Quinn 207, Boston, MA 02135, USA. bernadette.levesque@childrens.harvard.edu
authors.forename: Bernadette M
authors.initials: BM
authors.lastname: Levesque
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Kalish
authors.forename: Justine
authors.initials: J
authors.lastname: LaPierre
authors.forename: Maureen
authors.initials: M
authors.lastname: Welch
authors.forename: Virginia
authors.initials: V
authors.lastname: Porter
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000191:economics* / Q000379:methods*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D016896:Treatment Outcome