Through dedication, hard work, research and partnership, Texas Children’s Newborn Center has lowered its rate of a serious lung condition in premature infants by more than 13 percent over the past year.
The center’s current rate of Bronchopulmonary Dysplasia (BPD) is below the national average for the first time in a decade and is well below what is expected based on the size of the unit and the type of patients cared for in the NICU at Texas Children’s Hospital, according to the Vermont Oxford Network, an organization that helps hospitals track outcomes of premature babies and allows comparison to other institutions across the country.
“This is a dramatic improvement for us,” said Dr. Monika Patil, one of the neonatologists involved in Texas Children’s campaign to lower BPD rates. “We now have the lowest rate of BPD since we joined the Vermont Oxford Network in 2006.”
Patil said every team member in the Newborn Center contributed to this outstanding achievement and that their work has been directed by the Avoiding Lung Injury (ALI) team. ALI is a multidisciplinary group focused on improving the respiratory outcomes of very low birth weight infants in the NICU through quality improvement projects. This team was created by Dr. Lakshmi Katakam, medical director of the NICU, and Dr. Gautham Suresh, chief of Neonatology, with the vision of empowering NICU staff to tackle one of the most important determinants of long-term outcomes in premature babies – that is, whether or not a premature infant develops BPD.
BPD is one of the key conditions that influences long-term outcomes in a low birth weight infant, Katakam added. And, for many infants, it determines whether they go home on oxygen or ventilator. That’s why close monitoring of these patients is so important.
What ALI has found, and clinicians have worked to implement, is that rates of BPD can be lowered if infants who need respiratory aid are treated with gentler modes of therapy that protect the premature baby’s lungs from being injured , such as Continuous Positive Airway Pressure (CPAP) instead of being intubated and placed on a ventilator. If intubation and assistance of ventilator are necessary, the group discovered infants fare better if clinicians closely watch the amount of ventilator support and oxygen being administered, only giving infants what they needed when they need it.
To implement and maintain these changes, the Newborn Center is trying innovative staffing models that enable nurses and respiratory therapists to become even more involved in respiratory care of premature patients. Instead of tending to more than one patient during their shift, nurses caring for infants on CPAP are now assigned to care for only one patient at a time during the first few days of life when premature babies’ lungs are most vulnerable to injury. There is also a team lead respiratory therapist that offers an extra layer of support and keeps a watchful eye to ensure that CPAP is successful.
“This method of care is highly involved and requires a lot of support from our nurses and respiratory therapists, but is what’s best for our patients during such a critical period in their lives,” Katakam said. “It’s also what sets us apart from other institutions that might not have the resources to give patients such individualized care.”
To ensure such close care is continued, the Newborn Center is working alongside nursing leaders, Rebecca Schiff and Heather Cherry, to perform a nursing research project to improve CPAP management. The project is focused on understanding the correlation between nurse-patient ratios and respiratory outcomes in infants on CPAP.
In addition, the ALI group is continuing its efforts to research and implement strategies for minimizing time a newborn spends on the ventilator by extubating as early as possible, using gentle ventilation modes, optimizing use of medications proven to be effective in reducing BPD, and minimizing exposure to oxygen, which can be harmful to premature infant’s lungs and eyes, if used in excess.
The ALI team is hosting a regional respiratory care conference on October 19 at Texas Children’s Hospital. NICU providers from all across the country will share their experiences and learn from experts at Texas Children’s. For more information about the First Annual Baylor Avoiding Lung Injury conference, please contact Katakam at Katakam@bcm.edu or ext. 6-1365. Online registration is available at https://www.bcm.edu/bali-conference.
“We are very excited about our progress but still have a long way to go,” Katakam said. “Preventing BPD is an ongoing effort but our team is determined and energized to do everything we can to prevent lung injury along a premature infant’s journey, from the time a baby takes the first breath in the delivery room to the time they leave our NICU.”
Excluding those mentioned above, those involved in the NICU’s effort to lower the rate of BPD in premature infants include:
- Isa Baruah
- Dr. Rebecca Cavazos
- Dr. Milenka Cuevas
- Dr. Shaeequa Dasnadi
- Anne Debuyserie
- Dr. Cary Fernandes
- Jennifer Gallegos
- Dr. Behru Gandhi
- Suzanne Iniguez
- Sheela John
- Maxine Keller
- Dr. Brian King
- Dr. George Mandy
- Jessica Ramirez
- Dr. Rita Shah
- Kymberly Sherwood
- Dr. Binoy Shivanna
- Dr. Nathan Sundgren
- Eva Vuong