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Hemodynamic Quality Improvement Bundle to Reduce the Use of Inotropes in Extreme Preterm Neonates
Pediatric Drugs ( IF 3.7 ) Pub Date : 2022-04-26 , DOI: 10.1007/s40272-022-00502-5
Sujith Kumar Reddy Gurram Venkata 1 , Ankur Srivastava 1 , Prashanth Murthy 1 , James N Scott 2 , Hussein Zein 1 , Lara Leijser 1 , Anirban Ghosh 1 , Sarfaraz Momin 1 , Sumesh Thomas 1 , Khorshid Mohammad 1
Affiliation  

Background

We evaluated the effect of the quality improvement (QI) bundle on the rate of inotrope use and associated morbidities.

Methods

We included inborn preterm neonates born at < 29 weeks admitted to level III NICU. We implemented a QI bundle focusing on the first 72 h from birth which included delayed cord clamping, avoidance of routine echocardiography, the addition of clinical criteria to the definition of hypotension, factoring iatrogenic causes of hypotension, and standardization of respiratory management. The rate of inotropes use was compared before and after implementing the care bundle. Incidence of cystic periventricular leukomalacia (cPVL) was used as a balancing measure.

Results

QI bundle implementation was associated with significant reduction in overall use of inotropes (24 vs 7%, p < 0.001), dopamine (18 vs 5%, p < 0.001), and dobutamine (17 vs 4%, p < 0.001). Rate of acute brain injury decreased significantly: acute brain injury of any grade (34 vs 20%, p < 0.001) and severe brain injury (15 vs 6%, p < 0.001). There was no difference in the incidence of cPVL (0.8 vs 1.4%, p = 0.66). Associations remained significant after adjusting for confounding factors.

Conclusions

A quality improvement bundled approach resulted in a reduction in inotropes use and associated brain morbidities in premature babies.



中文翻译:

减少极早产儿正性肌力药使用的血流动力学质量改进包

背景

我们评估了质量改进 (QI) 捆绑包对正性肌力药使用率和相关发病率的影响。

方法

我们纳入了 29 周内出生的早产儿,他们入住 III 级 NICU。我们实施了一个 QI 捆绑包,重点关注出生后的第一个 72 小时,其中包括延迟脐带钳夹、避免常规超声心动图检查、在低血压定义中增加临床标准、考虑低血压的医源性原因以及呼吸管理的标准化。在实施护理包之前和之后比较正性肌力药的使用率。囊性脑室周围白质软化症(cPVL)的发生率被用作平衡措施。

结果

QI 捆绑实施与正性肌力药(24 对 7%, p  < 0.001)、多巴胺(18 对 5%,p  < 0.001)和多巴酚丁胺(17 对 4%,p < 0.001)的总体使用显着减少相关 。急性脑损伤率显着下降:任何级别的急性脑损伤(34 vs 20%,p  < 0.001)和严重脑损伤(15 vs 6%,p  < 0.001)。cPVL 的发生率没有差异(0.8 对 1.4%,p  = 0.66)。在调整混杂因素后,关联仍然显着。

结论

质量改进捆绑方法导致早产儿正性肌力药的使用和相关的脑部疾病减少。

更新日期:2022-04-27
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