title: Evaluation of a practice guideline for the management of respiratory distress syndrome in preterm infants: A quality improvement initiative.
abstract: BACKGROUND
  The use of mechanical ventilation to treat respiratory distress syndrome in preterm infants has been associated with the development of bronchopulmonary dysplasia. As part of a quality improvement initiative to reduce the incidence of bronchopulmonary dysplasia in preterm infants, a new practice guideline for the management of respiratory distress syndrome was developed and adopted into practice in a neonatal intensive care unit in February 2012.
  
  
  OBJECTIVE
  To evaluate the effects of implementing the new guideline in regard to the use of mechanical ventilation and surfactant, and the incidence of bronchopulmonary dypslasia.
  
  
  METHODS
  An historical cohort of very preterm infants (gestational age 26(0) to 32(6) weeks) born one year before guideline implementation was compared with a similar cohort of infants born one year following guideline implementation. Data were collected retrospectively from the local neonatal intensive care unit database.
  
  
  RESULTS
  A total of 272 preterm infants were included in the study: 129 in the preguideline cohort and 143 in the postguideline cohort. Following the implementation of the guideline, the proportion of infants treated with ongoing mechanical ventilation was reduced from 49% to 26% (P<0.001) and there was a trend toward a reduction in bronchopulmonary dysplasia (27% versus 18%; P=0.07). There was no difference in the proportion of infants treated with surfactant (54% versus 50%).
  
  
  CONCLUSIONS
  The implementation of the practice guideline helped to minimize the use of ongoing mechanical ventilation in preterm infants.
authors.affiliation: Division of Neonatal-Perinatal Medicine, Children's Hospital, London Health Sciences Centre;
authors.forename: Brooke
authors.initials: B
authors.lastname: Read
authors.affiliation: Division of Neonatal-Perinatal Medicine, Children's Hospital, London Health Sciences Centre;; Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario;
authors.forename: David Sc
authors.initials: DS
authors.lastname: Lee
authors.affiliation: Centre for Nursing and Health Studies, Athabasca University, Athabasca, Alberta;; St Boniface General Hospital, Winnipeg, Manitoba.
authors.forename: Debbie
authors.initials: D
authors.lastname: Fraser
keywords: Bronchopulmonary dysplasia; Mechanical ventilation; Practice guideline; Preterm infants; Quality improvement; Respiratory distress syndrome