Novel prevention bundle reduces rates of bronchopulmonary dysplasia in infants: JAMA
California: Implementation of a detailed bronchopulmonary dysplasia (BPD) prevention bundle results in a sustained low rate of BPD in children, researchers report in the latest study published in JAMA Network Open.
Bronchopulmonary dysplasia or chronic lung disease is a common, serious complication that occurs mostly in premature infants. The rates of BPD continue to be high and have not changed much in the last decade. Maria Fe B. Villosis, Kaiser Permanente Panorama City, Panorama City, California, and the team, therefore, aimed to develop a consistent BPD prevention bundle in a systematic approach to decrease BPD.
"We, herein, describe a single-center quality improvement initiative to develop a BPD prevention system of care that is associated with a decrease in rates of BPD," wrote the authors.
Villosis et al conducted a quality improvement study that included 484 infants with birth weights from 501 to 1500 g. The infants were admitted to a level 3 neonatal intensive care unit in the Kaiser Permanente Southern California system from 2009 through 2019. The study period was divided into three periods: 1, baseline (2009); 2, initial changes based on ongoing cycles of Plan-Do-Study-Act (2010-2014); and 3, full implementation of successive Plan-Do-Study-Act results (2015-2019).
The primary outcome was BPD in infants with less than 33 weeks gestational age (hereafter referred to as BPD <33).
The study population included 484 infants with a mean birth weight of 1070 g; mean gestational age of 28.6 weeks; 252 female infants (52.1%); and 61 Black infants (12.6%).
The research yielded the following findings:
- During the 3 study periods, BPD <33 decreased from 9 of 29 patients (31.0%) to 3 of 184 patients (1.6%); special cause variation was observed.
- The standardized morbidity ratio for the adjusted BPD <33 decreased from 1.2 in 2009 to 0.4 in 2019.
- The rates of combined grades 1, 2, and 3 BPD decreased from 7 of 29 patients (24.1%) to 17 of 183 patients (9.3%).
- Grade 2 BPD rates decreased from 3 of 29 patients (10.3%) to 5 of 183 patients (2.7%).
- Adjusted median PMA at home discharge decreased by 2 weeks, from 38.2 weeks in 2009 to 36.8 weeks during the last 3 years (2017-2019) of the full implementation period.
- Adjusted mortality was unchanged, whereas adjusted mortality or specified morbidities decreased significantly
"Our findings revealed a sustained low rate of BPD in infants following the implementation of a detailed BPD system of care," concluded the authors.
The study titled, "Rates of Bronchopulmonary Dysplasia Following Implementation of a Novel Prevention Bundle," is published in JAMA Network Open.