INTRODUCING QUALITY IMPROVEMENT TECHNIQUES TO MINIMIZE TIME AND ITS VARIATIONS FOR SURFACTANT REPLACEMENT THERAPY IN PRETERM INFANTS

Main Article Content

Dr. Tejal Odedara
Dr. Binoy Shah
Dr. Ashish Mehta

Keywords

.

Abstract

In India, neonatal and perinatal outcomes exhibit significant variation, with some units achieving excellent results while others experience higher mortality and morbidity rates. Premature infants suffering from surfactant insufficiency due to poor lung development often develop respiratory distress syndrome (RDS), which can lead to acute pulmonary injury, neonatal death, or chronic lung disease if not promptly addressed with surfactant administration and assisted ventilation. This study investigates a quality improvement program implemented in intensive care settings to reduce surfactant receipt time and address key bottlenecks, ultimately improving neonatal survival. The objective is to assess the impact of timely surfactant administration through systematic quality improvement steps. The methodology involves three phases: observation to identify issues causing delays, three intervention cycles targeting enhanced communication, NICU preparation, prompt referral, and an evaluation phase to measure progress. Results show a significant reduction in surfactant receipt time after the interventions, demonstrating the positive impact of the Quality Improvement Program on neonatal health and outcomes. In conclusion, this study highlights the potential for other intensive care settings to adapt to similar changes, emphasizing training and sensitization of team members and a commitment to improvement to enhance neonatal survival.

Abstract 66 | PDF Downloads 48

References

1. Canpolat FE, Kadıoğlu Şimşek G, Webbe J, Büyüktiryaki M, Karaçağlar NB, Elbayiyev S, Kanmaz Kutman HG. Late Administration of Surfactant May Increase the Risk of Patent Ductus Arteriosus. Front Pediatr. 2020;8:130.
2. Ekhaguere OA, Okonkwo IR, Batra M, Hedstrom AB. Respiratory distress syndrome management in resource limited settings-Current evidence and opportunities in 2022. Front Pediatr. 2022;10:961509.
3. Desai, S. A., Tule, P., &Nanavati, R. N. (2017). Labour room Continuous Positive Airway Pressure (LR CPAP) in preterm neonates <34 weeks: An Indian experience. Sudanese Journal of Paediatrics, 17(2), 30–34.
4. Dylag AM, Tulloch J, Paul KE, Meyers JM. A Quality Improvement Initiative to Reduce Bronchopulmonary Dysplasia in a Level 4 NICU-Golden Hour Management of Respiratory Distress Syndrome in Preterm Newborns. Children (Basel). 2021;8(4):301.
5. Sanchez Luna M, Unnebrink K, Martinez-Tristani M, Ramos Navarro C. Less Invasive Surfactant Administration: A Review of Current Evidence of Clinical Outcomes With Beractant. Cureus. 2022;14(10):e30223.
6. Goikoetxea E, Rivas A, Murgia X, Antón R. Mathematical modeling and numerical simulation of surfactant delivery within a physical model of the neonatal trachea for different aerosol characteristics. Aerosol Science and Technology. 2017;51(2):168-77.
7. Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Te Pas A, Plavka R, Roehr CC, Saugstad OD, Simeoni U, Speer CP. European consensus guidelines on the management of respiratory distress syndrome–2019 update. Neonatology. 2019;115(4):432-50.
8. Spitzer AR. Has quality improvement really improved outcomes for babies in the neonatal intensive care unit?. Clinics in Perinatology. 2017;44(3):469-83.
9. Horbar JD, Rogowski J, Plsek PE, Delmore P, Edwards WH, Hocker J, Kantak AD, Lewallen P, Lewis W, Lewit E, McCarroll CJ. Collaborative quality improvement for neonatal intensive care. Pediatrics. 2001;107(1):14-22.
10. Horbar JD, Carpenter JH, Buzas J. Collaborative quality improvement to promote evidence based surfactant for preterm infants: a cluster randomized trial. BMJ 2004;329:1e7.
11. Curtis JR, Cook DJ, Wall RJ. Intensive care unit quality improvement: A how to guide for the interdisciplinary team. Crit Care Med 2006;34:211e18.
12. Bookman L, Troy R, McCaffrey M, Randolph G. Using quality-improvement methods to reduce variation in surfactant administration. Quality and Safety in Health Care. 2010 ;19(5):e23-.