Decreasing delivery room intubations: A quality improvement project.

AIM: The delivery room intubation rate for babies born less than 32 weeks postmenstrual age (PMA) at the Mater Mothers' Hospital in 2017 was 51%. Delivery room intubation of preterm infants may be associated with an increased risk of developing bronchopulmonary dysplasia. This quality improvement project aimed to decrease the rate of delivery room intubation for infants born less than 32 weeks PMA. METHODS: A quality improvement process using the evidence-based practice for improving quality framework and Plan-Do-Study-Act cycles was undertaken from October 2018 to December 2019. Commencing bubble continuous positive airway pressure for initial resuscitation in the delivery room was the principal change idea. RESULTS: The delivery room intubation rate for infants born less than 32 weeks PMA before the commencement of this project was 48% (cohort 1, n = 221). There was a significant decrease in the rate to 37.2% while the project was being conducted (cohort 2, n = 277) and a further significant reduction to 28.2% after introducing bubble continuous positive airway pressure in the delivery room (cohort 3, n = 202). There was a significant improvement in admission temperatures and a significant decrease in mortality rate between cohort 1 and cohort 2 but not between cohort 2 and cohort 3. There was no change in the rate of discharge home on oxygen between cohorts. CONCLUSIONS: This quality improvement project led to a significantly decreased delivery room intubation rate in infants born less than 32 weeks PMA. There was no evidence of any adverse outcomes with this approach.

Preterm infants at discharge: nap polysomnography versus 24-hour oximetry.

AIM: This study aimed to determine whether measures of intermittent hypoxia derived from 24-hour oximetry correlate with measures of apnoea derived from modified nap polysomnography undertaken for preterm infants before discharge. METHODS: Infants born ≤32 weeks of gestation were recruited from the neonatal intensive care unit and had a modified polysomnography to assess their respiratory stability once they were ≥35 weeks of postmenstrual age. Infants were defined as unstable if they had more than 10 obstructive events per hour or any apnoea of >20 seconds in length. Infants also had a 24-hour oximetry performed during this period. The results of the 24-oximetry desaturation index (DSI) were compared to nap polysomnography results for central and obstructive apnoea indices and correlations tested. RESULTS: Twenty-four infants completed the study. There were 15 (63%) infants defined as unstable by the modified polysomnography. The 3% DSI and 4% DSI from the 24-hour oximetry were significantly higher in the unstable infants, and values for all infants correlated with the obstructive index and the central apnoea index from the modified polysomnography. CONCLUSION: The 3% DSI and 4% DSI values from a 24-hour oximetry study may provide noninvasive measures of respiratory stability in preterm infants ready for discharge.