Fellow University of Utah School of Medicine Salt Lake City, Utah, United States
Background: Since 2011, when the Neonatal Resuscitation Program incorporated Continuous Positive Airway Pressure (CPAP) for newborns with labored breathing and hypoxia, CPAP use has increased at our institution. We've also observed a rise in "short-term" NICU admissions ( < 48 hours) due to respiratory failure. Objective: We hypothesized that an early respiratory assessment tool can reduce CPAP utilization, minimize short-term NICU admissions, and enhance maternal-infant bonding. Design/Methods: This is an ongoing quality improvement project that began in January 2020, with results reported through August 2022. We implemented the Respiratory Distress Scoring Tool on November 15, 2021, and conducted a retrospective analysis using delivery summaries and NICU progress notes for infants resuscitated by a pediatric resident team. Monthly CPAP rates and NICU admission data were analyzed before and after tool implementation through SPC run charts and T-tests. Results: Tool utilization and documentation steadily increased. By July 2022, 43% of eligible infants had a score documented. Post-implementation, the monthly CPAP rate during pediatric team resuscitations decreased from 28% to 21% (P < 0.001), consistently maintaining a 1-2 standard deviation reduction from the pre-tool average. Infants transitioning with their mothers increased from 51% to 58% (P = 0.02). While short-term NICU admissions for respiratory failure decreased from 5.8% to 4.3% among infants resuscitated by pediatric teams, this change did not reach statistical significance.
Conclusion(s): Implementation of a respiratory distress scoring tool was associated with a reduction in overall use of CPAP, a decrease in short-term NICU admissions, and an increase maternal-infant bonding. Ongoing education and acceptance of the new process have led to increased tool utilization. Future efforts will focus on preventing unnecessary NICU transfers due to overreliance on the scoring system and long-term analysis of NICU admissions.
