title: Chronic lung disease in very low birth weight infants: Persistence and improvement of a quality improvement process in a tertiary level neonatal intensive care unit.
abstract: OBJECTIVE
  We previously demonstrated a significant reduction in our incidence of chronic lung disease in our NICU using potentially better practices of avoiding delivery room endotracheal intubation and using early nasal CPAP. We sought to demonstrate whether these improvements were sustained and or improved over time.
  
  
  METHODS
  We conducted a retrospective, cross-sectional analysis of infants 501-1500 grams born at our hospital between 2005 and 2013. Infants born during the 2005-2007, 2008-2010 and 2011-2013 epochs were grouped together, respectively. Descriptive analysis was conducted to determine the number and percent of maternal and neonatal characteristics by year grouping. Chi-squared tests were used to determine whether there were any statistically significant changes in characteristics across year groupings.. Two outcome variables were assessed: a diagnosis of chronic lung disease based on the Vermont Oxford Network definition and being discharged home on supplemental oxygen.
  
  
  RESULTS
  There was a statistically significant improvement in the incidence of chronic lung disease in infants below 27 weeks' gestation in the three year period in the 2011-2013 cohort compared with those in the 2005-2007 cohort. We also found a statistically significant improvement in the number of infants discharged on home oxygen with birth weights 751-1000 grams and infants with gestational age less than 27 weeks in the 2011-2013 cohort compared to the 2005-2007 cohort.
  
  
  CONCLUSIONS
  We demonstrated sustained improvement in our incidence of CLD between 2005 and 2013. We speculate that a multifaceted strategy of avoiding intubation and excessive oxygen in the delivery room, the early use of CPAP, as well as the use of volume targeted ventilation, when needed, may help significantly reduce the incidence of CLD.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Greater Baltimore Medical Center, Baltimore, MD, USA.
authors.forename: H J
authors.initials: HJ
authors.lastname: Birenbaum
authors.affiliation: Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: E R
authors.initials: ER
authors.lastname: Pfoh
authors.affiliation: Division of Neonatology, Department of Pediatrics, Greater Baltimore Medical Center, Baltimore, MD, USA.
authors.forename: S
authors.initials: S
authors.lastname: Helou
authors.affiliation: Division of Neonatology, Department of Pediatrics, Greater Baltimore Medical Center, Baltimore, MD, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Pane
authors.affiliation: Division of Neonatology, Department of Pediatrics, Greater Baltimore Medical Center, Baltimore, MD, USA.
authors.forename: G A
authors.initials: GA
authors.lastname: Marinkovich
authors.affiliation: Division of Neonatology, Department of Pediatrics, Greater Baltimore Medical Center, Baltimore, MD, USA.
authors.forename: A
authors.initials: A
authors.lastname: Dentry
authors.affiliation: Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Hsin-Chieh
authors.initials: HC
authors.lastname: Yeh
authors.affiliation: Division of Neonatology, Department of Pediatrics, Greater Baltimore Medical Center, Baltimore, MD, USA.
authors.forename: L
authors.initials: L
authors.lastname: Updegraff
authors.affiliation: Division of Neonatology, Department of Pediatrics, Greater Baltimore Medical Center, Baltimore, MD, USA.
authors.forename: C
authors.initials: C
authors.lastname: Arnold
authors.affiliation: Division of Neonatology, Department of Pediatrics, Greater Baltimore Medical Center, Baltimore, MD, USA.
authors.forename: S
authors.initials: S
authors.lastname: Liverman
authors.affiliation: Division of Neonatology, Department of Pediatrics, Greater Baltimore Medical Center, Baltimore, MD, USA.
authors.forename: H
authors.initials: H
authors.lastname: Cawman
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D045422:Continuous Positive Airway Pressure; D003430:Cross-Sectional Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008171:Lung Diseases / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States
keywords: Chronic lung disease; nasal CPAP; persistence; quality improvement; very low birth weight