The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

ENHANCED ROLE OF NICU BASED RESPIRATORY THERAPISTS IN AN ACADEMIC PERINATAL CENTER'S NEONATAL DELIVERY ROOM TEAM: A BWH NICU QUALITY IMPROVEMENT PROJECT

Christine Pantano1, Carrie Dodge1, Matthew Vanasse1, Robert M. Insoft2



Background: Neonatal Registered Respiratory Therapists (NRRT) serve varied roles in the Neonatal Intensive Care Unit. In our large perinatal center, they routinely attend deliveries for patients that are high-risk and also <29 weeks gestational age (GA). The 5th edition of the Neonatal Resuscitation Program (NRP) highly recommends the use of blended oxygen for initial resuscitation to patients born 32 weeks GA to avoid possible long-term effects of high oxygen concentrations. This has prompted the expansion of our program to include an NRRT for all deliveries between 29-32 weeks GA with the primary goals of airway management, assisting in the use of the T-piece resuscitator and oxygen(FiO2) administration and weaning. Our plan is to measure the impact of the NRRT expanded role in our center's (8,900 births/yr) resuscitation team, which includes NICU residents, nurses and fellows. We hypothesize that the addition of the NRRT to our DR team for the 29-32 weeks GA will result in decreased DR and NICU admission FiO2 levels as well as early NICU morbidity.

Methods: A retrospective/prospective cohort with chi-square analysis, comparing neonates 29-32 weeks GA born 12/04-12/06(n=150) to neonates born after our new practice implementation starting 12/06-10/07(n=150). From birth, 24 hours of data was collected, including timing of intubations and extubations; FiO2 levels and saturations; time of surfactant dosing; and rate of pneumothoraces.

Results: We compare both the pre and post groups in key areas of our data collection within the first 24 hours of life. Demographic parameters include the following: Birth Weight in grams, mean(SD) / Gestational Age in weeks, mean(SD)/ Male Gender, n(%)/ Prenatal Steroids, n(%) / 1-minute APGAR score, median(IQR) / 5-minute APGAR score, median(IQR): Pre 1562(306)/ 31.1(1.1) / 84(56)/ 141(94) / 7(3-9) / 8(5-9), Post 1586(350) / 31.1(1.2) / 88(59) / 136(91) / 6(0-9) / 8(3-9). Measured results are seen on Table 1.

Conclusion: Implementation of the 5th edition of NRP at our perinatal center has prompted the expanded NRRT role of attending deliveries of 29-32 week GA. Analysis revealed both a reduction in time to 1st surfactant dosing and extubation to NCPAP. Admission FiO2, pneumothorax rates and oxygen saturations were statistically unchanged. We believe now the expanded role of the NRRT in the DR translates into enhanced respiratory management in key clinical areas in the first 24 hours of life for the 29-32 weeks GA infants