412 - Breathing Easier: A Pneumo Prevention Bundle and Respiratory Care Algorithm for Reducing Pneumothorax in Term Infants

Poster Number: 412
Publication Number: 412.2144

Background: Pneumothorax in term infant is a serious complication of an underlying disease with a high incidence of morbidities, mortality and an increased length of stay (LOS). The incidence rate has been reported to vary from 1.5% to 13.5% .

Objective: Achieving a 50% Reduction in Spontaneous Pneumothorax rate in Live Term Infants from January 2020 to December 2020 in Institution #1 and from January 2022 to December 2022 in institution #2 through the Implementation of the Respiratory Care Algorithm (RCA) and Pneumo Prevention Bundle (PPB) in the Delivery room (DR) and NICU.

Design/Methods: Due to an increase in radiologically confirmed pneumothorax cases in term infants, our NICU chart Review committee conducted a detailed analysis. We found a common issue: improper CPAP use in DR and failure to obtain a CXR on admission to NICU. Our Quality Improvement project aimed to reduce pneumothorax with a standardized protocols with 'PPB' and 'RCA' and educated our staff. Our commitment to improvement included monthly chart reviews of pneumothorax cases to assess compliance and identify potential barriers. Monthly chart reviews, immediate feedback, and transparent communication in staff meetings ensured progress and compliance.

Results: Institution #2 achieved a remarkable 98% reduction in the first year and 100% reduction in the second year. Institution #1 recorded approximately a 60% reduction in the first year, followed by an impressive 81% reduction in 2023. Due to staff turnover at Institution #1, progress was slower compared to Institution #2. Nevertheless, this significant achievement contributed to a decrease in NICU admissions for pneumothorax diagnosis in both institutions, fostering an environment that encouraged mother-baby bonding and breastfeeding. The utilization of a standardized algorithm also played a pivotal role in reducing the need for chest tube placements in small to moderate cases. Notably, there was a trend towards reduced LOS, with the average dropping from 3.5 to 3 days. Furthermore, the utilization of chest tubes or pigtail catheter use decreased from an average of 2 per year to 0 per year. This trend was consistently observed and validated in Institution #2.

Conclusion(s): The implementation of a standardized RCA and a PPB successfully reduced the incidence of pneumothorax in term infants at two distinct institutions. By eliminating variability in delivery room (DR) care for infants experiencing respiratory distress and utilizing a standardized algorithm, coupled with a robust adherence review process, a significant reduction in pneumothorax cases among term infants can be achieved.