Effects of quality improvement in delivery room resuscitation on very or extremely low birth weight infants

Objective To explore the effects of quality improvement in delivery room resuscitation on very/extremely low birth-weight infants (VLBWI/ELBWI). Methods A retrospective analysis was performed to analyze the clinical data of VLBWI/ELBWI who were admitted to the Neonatal Intensive Care Unit (NICU) of Nanjing Maternity Hospital Affiliated to Nanjing Medical University from January to December 2015 (pre-improvement group, n=176) and of those who were admitted from January to December 2016 after the implementation of quality improvement program on delivery room resuscitation (post-improvement group, n=199). Several parameters were monitored, including resuscitation modalities [continuous positive airway pressure (CPAP) , peak inspiratory pressure (PIP)+positive end expiratory pressure (PEEP) with T-piece resuscitator and intubation rate in delivery room], neonatal body temperature and pH on NICU admission, respiratory outcomes, morbidity from intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity and hospitalization. Chi-square (or Fisher's exact test), t or rank Sum test was used for statistical analysis. Results There was no significant difference in gestational age, birth weight, gender proportion, delivery mode and Apgar scores between the two groups (all P>0.05). After implementing the quality improvement program, there was an increased overall usage of CPAP [85.9% (171/199) vs 66.3% (112/176), χ2=19.881, P 0.05) . The average admission temperature increased after launching the quality improvement program [M (P25-P75), 36.2 (35.8-36.5) vs 35.6 (35.4-35.7)℃, Z=-9.681, P<0.01]. The morbidities of pulmonary hemorrhage within one week after birth [1.5% (3/199) vs 5.1% (9/176), χ2=3.921] and grade Ⅲ/Ⅳ intraventricular hemorrhage [1.1% (2/199) vs 11.9% (21/176), χ2=33.885] decreased along with the improvement in delivery room resuscitation (both P<0.05). The duration of invasive ventilation decreased as well [3 (1-6) vs 4 (2-9) d, Z=-2.286, P<0.05]. Conclusions Quality improvement in delivery room resuscitation measures standardizes the management of delivery room resuscitation and improves the clinical outcomes of VLBWI/ELBWI. Key words: Delivery rooms; Resuscitation; Quality improvement; Infant, extremely low birth weight; Infant, very low birth weight