P1.245: A Quality Improvement Project to Standardize Surfactant Delivery During the Golden Hour in Preterm Infants Born at ≤ 30 weeks

Purpose/Objectives: Bronchopulmonary Dysplasia (BPD) remains a significant complication in preterm infants, particularly those born at ≤ 30 weeks gestation. Timely surfactant administration within the first hour of life, or the "golden hour," is crucial in reducing the risk of BPD in infants who require invasive ventilation soon after birth. However, inconsistent practices regarding surfactant delivery contribute to variable outcomes. To address this, we implemented a change in workflow to ensure timely surfactant administration and improve process efficiency.

Design/Methods: The Global Aim of this Quality Improvement initiative is to reduce BPD in preterm infants. A multidisciplinary team worked on improving documentation of BPD diagnosis in the medical records to accurately determine our baseline incidence of BPD in March of 2023. Along with optimizing the use of non-invasive respiratory support to minimize need for early invasive ventilation, the team identified delayed surfactant administration beyond the golden hour in those who did need intubation at birth as an area in need of improvement . Our SMART aim is to increase the percentage of infants who receive surfactant within the first hour of life among infants born in our facility at less than or equal to 30 weeks gestational age (GA) from a baseline of 50% to 90% by March of 2024. Our unit practice guidelines recommend confirmation of appropriate endotracheal (ET) tube position prior to surfactant administration. A process map was created delineating each step from birth up until surfactant administration and delays were identified. To streamline this process, we implemented a change in workflow that expedited admission, order entry, and X-ray.
This new workflow was introduced to all NICU providers during monthly meetings starting in November 2023, with a “Go-Live” date of December 4th, 2023. Visual reminders outlining the new workflow were placed in provider work rooms in the unit and in Labor and Delivery Resuscitation room for easy reference. Continuous feedback was provided to staff on their adherence to the new process.

Results: A total of 208 infants ≤ 30 weeks gestation were born at the University of Mississippi Medical Center between January 2023 and December 2024, of which 82% required surfactant therapy. Of these, the percentage that received surfactant within the golden hour increased from a baseline average of 50% to 82%. Additionally, the incidence of Bronchopulmonary Dysplasia (BPD) in the unit decreased from a baseline rate of 60% to 38.7%. We also noticed a dramatic decrease in the incidence of grade 3 BPD from baseline of 20.8% to 6%.

Conclusion/Discussion: Streamlining the process of surfactant administration significantly improved timely delivery of surfactant within the golden hour in preterm infants born at ≤ 30 weeks gestational age.