109 - Implementation of a Quality Improvement Intervention to Reduce Bronchopulmonary Dysplasia in Very Low Birth Weight Infants at 4 NEOCOSUR Centers.

Publication Number: 4107.109

Alvaro J. González, Pontificia Universidad Católica de Chile, Santiago, Region Metropolitana, Chile; Alberto Toso, Pontificia Universidad Catolica de Chile, Santiago, Region Metropolitana, Chile; Daniela Sandino, Hospital Gustavo fricke, Concón, Valparaiso, Chile; Fernando Silvera, Pereira Rossell Hospital, Montevideo, Montevideo, Uruguay; Andrea Maccioni, Pontificia Universidad Católica de Chile, Hospital Dr. Sótero del Río, Santiago, Region Metropolitana, Chile; Andrea Montenegro, Hospital Cayetano Heredia, Lima, Lima, Peru; Catalina Vaz-Ferreira, Pereira Rossell Childrens Hospital, Montevideo, Montevideo, Uruguay; Galo D. Bajaña, Hospital Dr. Gustavo Fricke, VIÑA DEL MAR, Valparaiso, Chile; María Paz Cubillos, Hospital Dr Sotero del Rio Chile, Santiago, Region Metropolitana, Chile; Sandra Rado Peralta, Hospital Cayetano Heredia, Lima, Lima, Peru; Angélica Domínguez, Pontificia Universidad Católica de Chile, Santiago, Region Metropolitana, Chile; Roger F. Soll, Robert Larner, M.D., College of Medicine at the University of Vermont, Hinesburg, VT, United States; Jose L Tapia, Pontificia Universidad Catolica de Chile, Santiago, Region Metropolitana, Chile

Background: Bronchopulmonary dysplasia (BPD) is the most frequent long-term morbidity in very low birth weight (VLBW) infants, affecting 20 to 25% of them in our network. The development of BPD is strongly influenced by early respiratory care practices. Previous efforts to lower BPD rates in our network achieved only modest improvements, with high variability among centers and challenges in implementing evidence-based gentle respiratory care.

Objective: To reduce the combined outcome of BPD (oxygen at 36 weeks’ postmenstrual age (PMA)) and/or death in VLBW infants through a collaborative Quality Improvement (QI) intervention in four NEOCOSUR centers.

Design/Methods: We conducted a prospective QI project from March 2024 to September 2025 in four centers with high BPD rates. Following an eight-month observational and educational phase, an 18-month intervention implemented a bundle of evidence-based practices: antenatal steroids, optimized delivery room care (avoiding unnecessary intubation), early or prophylactic CPAP, judicious oxygen use, minimal intubation, early surfactant, non-invasive support, and early extubation. Balance measures included surfactant use, air leaks, and postnatal steroid exposure. The QI strategy incorporated multidisciplinary training, expert visits, online follow-up, continuous monitoring of process and outcome indicators, checklists, run charts, and bi-or tri-monthly PDSA cycles.

Results: A total of 290 inborn VLBW infants (400–1500 g; 23–34 weeks GA) were included during the intervention period. Patient characteristics during the intervention period by center are shown in Table 1. Process improvements were substantial: mechanical ventilation decreased from 72.9% to 56.2% (p=0.013), and antenatal steroid exposure rose from 80.8% to 88.3% (p=0.003). Balance indicators such as surfactant use, air leaks and postnatal steroid use showed no significant increase (Table 2). Combined BPD/death fell from 51.4% pre-intervention to 40.5% post-intervention (p=0.0315) (Figure 1). Despite these improvements, variability persisted among centers, with BPD rates ranging from 12.3% to 58.1% (Table 1).

Conclusion(s): A collaborative QI respiratory care bundle significantly reduced BPD and/or death in VLBW infants, supported by major process changes. Persistent variability among centers underscores the need for sustained education and team engagement to promote gentle, less invasive practices.

Table 1 Patient Characteristics
Table 1 Patient Characteristics.pdf

Table 2 Process and Balance Indicators
Table 2 Process & balance Indicators.pdf

Figure 1: BPD and/or Death in VLBW Infants: Monthly P-Chart from Four NEOCOSUR Centers
Figure 1.pdf