O2163: Bubble Breaths: A Quality Improvement Approach to Improve Adherence to Bubble CPAP in Preterm infants with Respiratory Distress Syndrome.

Purpose/Objectives:

Background:
Exposure to mechanical ventilation (MV) is a risk factor for bronchopulmonary dysplasia (BPD) in very preterm infants. The 2014 AAP policy statement recommends starting Continuous Positive Airway Pressure (CPAP) as an alternative to intubation, even in extremely preterm infants, as it increases the chances of staying extubated.

Objective:
This quality improvement project aims to improve CPAP adherence in infants from 26- 32 weeks' gestation within the first 72 hours of life, targeting an increase from 45% to 60% by December 1, 2024, with the broader goal of reducing Bronchopulmonary Dysplasia (BPD) rates at Oishei Children’s Hospital, Buffalo. CPAP failure was defined as the need for mechanical ventilation within 72 hours after being placed on CPAP.

Design/Methods: Baseline data collected from January 2023 to March 2024 revealed only 45% adherence to bubble CPAP, leading to frequent escalation to Non-Invasive Positive Pressure Ventilation (NIPPV) or intubation. We aimed to increase CPAP adherence in infants born between 26-32 weeks gestational age (GA) from 45% to 60% within 72 hours of life by December 2024, aiming to reduce Bronchopulmonary Dysplasia (BPD). A quality improvement bundle was implemented for infants 26-32 weeks' GA admitted on bCPAP and adherence rate was tracked by using control charts. Interventions included standardized guidelines for respiratory support escalation and weaning, protocolized nasal interface selection to ensure an adequate nasal seal and multidisciplinary rounds to ensure appropriate bCPAP equipment setup.

Results: Of the 180 infants born under 32 weeks’ GA admitted on bCPAP, 125 infants belonged to the pre-implementation cohort and 91 infants were in the post-implementation group. Post implementation data showed an increase in bCPAP adherence from 45% to above 80% with reduced ventilator days.

Conclusion/Discussion: While the study is ongoing, early data is showing promising results. Adherence and compliance to the protocol have improved, suggesting the QI approach could lead to lasting improvements and culture change. Next steps include continuing bCPAP implementation in the delivery room and implementing less invasive surfactant administration (LISA) to further reduce BPD.