Clinical Study On Quality Improvement Of Birth Weight In Preterm Infants With A Birth Weight <1500g

Objective Develop quality improvement measures to improve the quality of the delivery room resuscitation on preterm infants with birth weight<1500 g at our institution.To explore the effects of quality improvement in delivery room resuscitation on these preterm infants.Methods A analysis was performed to analyze the clinical data of pretenn infants with birth weight<1500 g who were admitted to the Neonatal Intensive Care Unit(NICU)of Nanjing Maternity Hospital Affiliated to Nanjing Medical University from January to December 2015(pre-improvement group,n=176)and of those who were admitted from January to December 2016 after the implementation of quality improvement program on delivery room resuscitation(post-improvement group,n=199).Multiple improvement measures included setting up a neonatal resuscitation team,preventing heat loss,starting resuscitation with continuous positive airway pressure(CPAP),starting resuscitation from lower oxygen level,and more.Several parameters were monitored,including resuscitation modalities[CPAP,peak inspiratory pressure(PIP)+positive end expiratory pressure(PEEP)with T-piece resuscitator,positive pressure ventilation with Balloon and intubation rate in delivery room],neonatal body temperature and pH on NICU admission,respiratory outcomes,morbidity from intraventricular hemorrhage,necrotizing enterocolitis,retinopathy of prematurity and hospitalization.Chi square(or Fisher's exact test),t or Rank Sum test was used for statistical analysis.Results There was no significant difference in gestational age,birth weight,gender proportion,delivery mode and Apgar scores between the two groups(all P>0.05).After implementing the quality improvement program,there was an increased overall usage of CPAP[85.9%(171/199)vs 66.3%(112/176),?2=19.881,P<0.01]and PIP+PEEP with T-piece resuscitator[33.8%(67/199)vs 10.8%(12/176),?2=19.819,P<0.01],but a decreased usage of balloon catheter ventilation[6.0%(12/199)vs 39.3%(44/176),x2=53.682,P<0.01].No significant change in intubation rate was observed(P>0.05).The average admission temperature increased after launching the quality improvement program[M(P25-P75),36.2(35.8-36.5)vs 35.6(35.4-35.7)?,Z=-9.681,P<0.01].The morbidities of pulmonary hemorrhage within one week after birth[1.5%(3/199)vs 5.1%(9/176),?2=3.921]and grade ?/? intraventricular hemorrhage[1.1%(2/199)vs 11.9%(21/176),?2=33.885]decreased along with the improvement in delivery room resuscitation(both P<0.05).The duration of invasive ventilation decreased as well[3(1-6)vs 4(2-9)d,Z=-2.286,P<0.05].Conclusions Quality improvement in delivery room resuscitation measures standardizes the management of delivery room resuscitation and improves the clinical outcomes of the preterm infants with birth weight<1 500 g.