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.

中文翻译：

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使用捆绑方法预防早产儿支气管肺发育不良

背景： 

支气管肺发育不良 (BPD) 是一种慢性肺部疾病，影响约 20% 至 30% 的妊娠 32 周以下出生的婴儿。如果婴儿在 36 周校正年龄时需要氧疗或出院回家，则可做出诊断。BPD 会增加医疗费用、死亡率以及长期呼吸道并发症和神经感觉障碍的风险。

目的： 

该项目的目的是在不增加住院时间的情况下提高极早产儿 BPD 的发生率和严重程度。

方法： 

创建并实施了涉及呼吸支持和药物使用指南的多学科护理包，以及产房的无创通气算法。该捆绑包用于 2019 年在中西部一家医院出生、妊娠不足 32 周的婴儿，并将结果与​​ 2017 年出生的婴儿进行比较。

结果： 

实施这一 BPD 预防方案有助于减少早产儿出院时的氧气使用量，而无需增加住院时间。有创机械通气的使用和 BPD 的严重程度也有所下降。

对实践和研究的影响： 

多学科综合治疗方法可以成功降低早产儿 BPD 的发生率。未来的质量改进项目应侧重于改善极早产儿的产房管理，重点是优化无创通气策略。仍需要更多的研究来确定早产儿的最佳通气方法以及表面活性剂和皮质类固醇的最佳利用。