770 - Systematic Preventive Bundled Care and a Culture of Consistency Sustained Low Bronchopulmonary Dysplasia Rates in High-Risk Preterm Infants: A 10-Year NICU Quality Improvement Project

Publication Number: 1746.770

Maria Fe Villosis, Kaiser Permanente Bernard J. Tyson School of Medicine; Southern California Permanente Medical Group (SCPMG), Panorama City, CA, United States; Karine Barseghyan, Southern California Permanente Medical Group, Panorama City, CA, United States; Ma. Teresa Ambat, Kaiser Permanente Bernard J. Tyson School of Medicine, Panorama City, CA, United States; Kambiz Kevin. Rezaie, Kaiser Permanente - Panorama City Medical Center, Panorama City, CA, United States; Harry Chang, Kaiser Permanente Bernard J. Tyson School of Medicine, Panorama City, CA, United States; Alexandra Diamond, SCPMG, Panorama City, CA, United States; Abiola Olowoyeye, Kaiser Foundation Hospital Panorama City, Panorama City, CA, United States; Brian Lee, Kaiser Panorama City, Panorama City, CA, United States; Anna M. Munoz, Kaiser Foundation Hospital Panorama City, Panorama City, CA, United States; Fu-Sheng Chou, Southern California Permanente Medical Group, Riverside, CA, United States

Background: Bronchopulmonary dysplasia (BPD) remains the most common complication of early preterm birth, and its prevalence continues to rise despite advances in neonatal care in the United States and worldwide. Reported incidence varies widely, ranging from 2% to 68%, reflecting differences in clinical practice. Targeted quality improvement (QI) initiatives can reduce BPD, but sustained gains require consistent, standardized preventive care. The implementation of a systemic BPD prevention bundle that included respiratory roadmap, optimal oxygen saturation target of 85-95%, use of gentle ventilation by optimization of pressure and minimization of oxygen toxicity, and adjunct non-ventilatory therapies and other evidence-based strategies led to a sustainable reduction in BPD incidence among high-risk preterm infants at KFH-PC NICU.

Objective: 1. To determine the incidence of BPD, defined as oxygen (O2) use at 36 weeks postmenstrual age (PMA), and respiratory support regardless of O2 use at 36 weeks PMA, in the KFH-PC NICU over a 10-year period (2015-2024).
2. To evaluate the impact of systematic preventive bundled care approach, supported by a culture of consistency on BPD rates, mean PMA at discharge, and survival without major morbidity (SWMM).

Design/Methods: Data from 412 infants admitted to KFH-PC NICU between 2015-2024 were collected annually and reviewed retrospectively using the California Perinatal Quality Care Collaborative (CPQCC) and Vermont Oxford Network (VON) databases. Eligible infants were equal or < 29 weeks and/or Very Low Birthweight (equal or < 1500 grams).

Results: Over the 10-year period, the average BPD incidence at 36 weeks PMA using oxygen was 2% (range 0-8%).
In the most recent epoch (2022-2024), observed: expected ratio per VON was 0.3 (95th CI: 0.1-0.5). The risk adjusted BPD rate for our center using oxygen support was 4.2%, compared with 25.8% in the CPQCC network. BPD incidence on any respiratory support regardless of O2 (grades 1-3) was 5.9% versus 35% in the CPQCC network. No grade 3 BPD (intubated) was observed (CPQCC 2.6%). The adjusted PMA at discharge is 37 weeks, 2 weeks earlier than the CPQCC network (39 weeks). Survival without major morbidity was higher at our center than the CPQCC network (71.8% vs 60.3%).

Conclusion(s): A systematic preventive bundled care approach with a culture of consistency achieved and sustained reduction in BPD and improved outcomes over 10 years in high-risk preterm infant. These findings highlight the value of long-term quality improvement strategies and their potential applicability to other NICUs.

BPD Incidence among High Risk Premature Infants Born in 2015-2024 KFH-PC vs CPQCC Network
BPD rate O2 support at 36 wks 2015-2024 at 2% for KFH-PC vs 25% for CPQCC Network and
BPD Grade 1-3 at 36 wks 2015-2024 at 4% for KFH-PC vs 28% for CPQCC Network

Adjusted Mean PMA at Discharge among High risk Premature Infants 2022-2024
The adjusted PMA at discharge is 37 weeks for KFH-PC, 2 weeks earlier than the CPQCC network (39 weeks).

Adjusted Risk CLD Grade 1-3 among High Risk Premature Infants Born in 2015-2024 KFH-PC vs CPQCC Network
BPD incidence on any respiratory support regardless of O2 (grades 1-3) was 5.9% (KFH-PC) versus 35% (CPQCC network)