The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

DELAY IN SURFACTANT DELIVERY HAS NO RELATION TO THE DURATION OF NEONATAL INTENSIVE CARE UNIT STAY (NICU)

Elissa E. Kim1,2 , Daniel W. Sutton1,2, Robert L. Chatburn2,1, Susan M. Brant1,2, John Dickson1,2



Background: Very low birth weight (VLBW) neonates require extended stays in NICU (neonatal intensive care unit), creating stress for both the parents and the institution. Respiratory Distress Syndrome is the most common complication associated with premature infants. Surfactant therapy has been demonstrated to improve outcomes. Data from Hillcrest Hospital (HH) indicate a large variability in the time between birth and surfactant delivery. The purpose of this study is to determine if there is a correlation between delay in surfactant delivery (DISD) and duration of NICU stay in a community hospital.

Methods:
Data from 2004 to 2007 on VLBW neonates (<1500g) from the HH database were collected. Records of 128 neonates were reviewed, with 70 meeting entry criteria (mechanical ventilation and surfactant administration); 2 outliers were excluded. DISD was defined as the time (minutes) from birth to the first surfactant dose. NICU stay duration was measured in number of days. Linear correlation and regression statistics were used to evaluate the association between DISD and duration of NICU stay. Correlation associated with P values < 0.05 was considered significant.

Results:
Data were obtained for 68 births. Birth weight ranged from 476 grams to 1551 grams (median = 1,143 grams). Gestational age ranged from 22 weeks to 32 weeks (median = 29 weeks). DISD ranged from 7 minutes to 522 minutes (median = 46 minutes). There was no significant correlation between the delay and the duration of NICU stay (R2 = 0.003, P = 0.657).

Conclusions:
Unwarranted practice variation usually contributes to length of stay. However, in this case, the variation in surfactant delivery time relative to birth time was not related to the period of ICU stay for the VLBW neonates. Therefore, efforts to improve protocol compliance related to treatment delay would be wasted. This study illustrates the importance of focusing process improvement efforts on meaningful outcomes based on actual hypothesis tests.