The Science Journal of the American Association for Respiratory Care

2002 OPEN FORUM Abstracts

REDUCTION IN THE INCIDENCE OF CHRONIC LUNG DISEASE FOLLOWING THE IMPLEMENTATION OF A LUNG PROTECTIVE DELIVERY ROOM MANAGEMENT STRATEGY

Calvin Clark, RRT RCP, Barbara Prieur RRT RCP, Ann Ramirez RN, Donna Cravener RN, Brian Wood MD, Mission-St. Joseph’s Hospital, Asheville, North Carolina

Review of our outcome data demonstrated that the incidence of chronic lung disease (supplemental oxygen requirement at 36 weeks adjusted age) in infants with birth weights of less than or equal to 1500 grams cared for in our nursery was greater than that of our benchmark, the Vermont-Oxford Network. There are certain care practices that cause lung injury and are associated with an increased risk of developing chronic lung disease. We evaluated our practices, reviewed the medical literature, and developed a delivery room management strategy founded on evidence based medicine geared toward minimizing lung injury in the immediate postpartum period. These delivery room changes included the administration of Curosurf? (poractant alpha), a porcine lung surfactant, within the first 5 minutes of life, the use of the Fisher & Paykel Neopuff ? Infant Resuscitator to minimize over distention of the premature lung and maintain functional residual capacity with continuous positive airway pressure, and the use of oxygen blenders and saturation monitors in L&D and on the transport incubators to facilitate weaning of oxygen. During the first seven months of 2001 the incidence of our chronic lung disease was 58% (n=45). Following the institution of our new delivery room practice, the incidence of chronic lung disease during the last five months of 2001dropped to 30% (n=48). In addition to the improvement in our outcomes of chronic lung disease, other benefits were also apparent, such as the proportion of infants discharged from the hospital on supplemental oxygen decreased from 40% to 12%, and the average time on mechanical ventilation decreased from 21 days to 11 days. We feel that by comparing our outcomes to benchmark institutions we have improved our standard of care and the quality of life for our low birth weight infants.

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