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Bapat R, Nelin L, Shepherd E, Ryshen G, Elgin A, Bartman T. A multidisciplinary quality improvement effort to reduce bronchopulmonary dysplasia incidence. J Perinatol. 2020 Apr;40(4):681-687. doi: 10.1038/s41372-019-0574-8. Epub 2020 Jan 6. PMID: 31907398; PMCID: PMC7223819.

Background: Bronchopulmonary Dysplasia (BPD) is the most common prematurity complication. Although several practices have been proposed for BPD prevention, none of these in isolation prevent BPD.

Methods: Our initiative focused on two key drivers: oxygen management and noninvasive ventilation strategies. We created best practice guidelines and followed outcome measures using Shewhart control charts.

Results: PDSAs of protocols preceded a large-scale rollout of a “0.21 by 28” campaign in 2014 leading to a special cause reduction in the “any BPD” rate, and a decrease in severe BPD (from 57 to 29%). At the end of 2017, we reinvigorated the project, which led to dramatic decreases in the “any BPD” rate to 41% and the “severe BPD” rate to 21%.

Conclusions: A multidisciplinary QI initiative focused on process improvement geared towards the pathophysiological contributors of BPD has successfully reduced the rate of BPD in an all referral level IV NICU.

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