Using a Bundle Approach to Prevent Bronchopulmonary Dysplasia in Very Premature Infants

Background: Bronchopulmonary dysplasia (BPD) is a chronic lung disease that affects about 20% to 30% of infants born at less than 32 weeks of gestation. Diagnosis is made if an infant requires oxygen therapy at 36 weeks' corrected age or discharge home. BPD increases healthcare costs, mortality rates, and risk of long-term respiratory complications and neurosensory impairments. Purpose: The purpose of this project was to improve rates and severity of BPD in very premature infants without increasing length of hospitalization. Methods: A multidisciplinary care bundle involving respiratory support and medication use guidelines was created and implemented along with a noninvasive ventilation algorithm for the delivery room. This bundle was utilized for infants born in a Midwest hospital in 2019 at less than 32 weeks of gestation and the outcomes were compared to infants born in 2017. Results: Implementation of this BPD prevention bundle contributed to a decrease in the use of oxygen at discharge for very premature infants without increasing length of hospitalization. Use of invasive mechanical ventilation and the severity of BPD also decreased. Implications for Practice and Research: A multidisciplinary bundle approach can be successful in decreasing the rates of BPD for very premature infants. Future quality improvement projects should focus on improving delivery room management of extremely premature infants, with an emphasis on optimizing noninvasive ventilation strategies. More research is still needed to determine the best method of ventilation for premature infants and the best utilization of surfactant and corticosteroids.