title: A Quality Improvement Initiative to Reduce the Need for Mechanical Ventilation in Extremely Low Gestational Age Neonates.
abstract: ObjectiveLimiting early intubation and mechanical ventilation in extremely low gestational age neonates (ELGAN) may decrease neonatal morbidity and mortality. The aim of our study was to demonstrate the feasibility, efficacy, and tolerability of a delivery room respiratory management protocol, including delayed umbilical cord clamping (DUCC) in combination with optimized nCPAP with high PEEP levels and less invasive surfactant administration (LISA).Study DesignThis cohort quality improvement study analyzed the respiratory and neonatal outcomes of all consecutive infants born between 24+0and 26+6weeks' gestation before (period 1,n= 40) and after (period 2,n= 52) implementing the new protocol.ResultsCompared with the period 1 infants, the period 2 infants had a lower rate of intubation in the delivery room (31 vs. 90%,p= 0.001) and were less likely to need mechanical ventilation on day 3 (28 vs. 62%,p= 0.002) and during the hospital stay (75 vs. 92.5%,p< 0.05). The two groups did not differ in terms of mortality or neonatal morbidity.ConclusionA delivery room respiratory management protocol based on DUCC, optimized nCPAP with high PEEP levels, and LISA procedure is both feasible and safe, and improved ELGAN respiratory outcomes.
authors.affiliation: Department of Neonatology, University Hospital La Conception, Aix-Marseille University, Marseille, France.
authors.forename: Ludivine
authors.initials: L
authors.lastname: Templin
authors.affiliation: Department of Neonatology, University Hospital La Conception, Aix-Marseille University, Marseille, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Grosse
authors.affiliation: Department of Neonatology, University Hospital La Conception, Aix-Marseille University, Marseille, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Andres
authors.affiliation: Department of Neonatology, University Hospital La Conception, Aix-Marseille University, Marseille, France.
authors.forename: Clotilde Des
authors.initials: CD
authors.lastname: Robert
authors.affiliation: Department of Neonatology, University Hospital La Conception, Aix-Marseille University, Marseille, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Fayol
authors.affiliation: Division of Pediatrics, Lausanne University Hospital, University of Lausanne, Switzerland.
authors.forename: Umberto
authors.initials: U
authors.lastname: Simeoni
authors.affiliation: Department of Neonatology, University Hospital La Conception, Aix-Marseille University, Marseille, France.
authors.forename: Farid
authors.initials: F
authors.lastname: Boubred
mesh_terms: D058109:Airway Management / Q000379:methods / Q000592:standards; D002985:Clinical Protocols / Q000592:standards*; D015331:Cohort Studies; D003696:Delivery Rooms / Q000458:organization & administration; D005260:Female; D005602:France / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000401:mortality / Q000628:therapy; D008297:Male; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D058996:Quality Improvement; D012121:Respiration, Artificial / Q000379:methods / Q000706:statistics & numerical data; D013501:Surface-Active Agents / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D011663:Pulmonary Surfactants; D013501:Surface-Active Agents