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Multifaceted QI program greatly improves use of prophylactic surfactant for high-risk preterm infants

Preterm infants often don't have sufficient pulmonary surfactant, a lipid/protein compound that aids the transition from the fluid-filled lungs of the fetus to the air-filled lungs of the newborn. When this transition does not occur, the infant develops respiratory distress syndrome. (RDS). Prophylactic surfactant therapy immediately after birth is recommended for preterm infants to prevent RDS and other respiratory problems.

Although surfactant treatment reduces the risk of death and pneumothorax by 40 percent, few preterm infants routinely receive it, and many infants receive delayed treatment. This situation can be improved with a multifaceted quality improvement (QI) program, according to a study supported by the Agency for Healthcare Research and Quality (HS10528).

Preterm infants born at hospitals that participated in the QI program were significantly more likely than infants born at control hospitals to receive surfactant in the delivery room (55 percent vs. 18 percent) and to receive it much sooner after birth (median of 21 minutes vs. 78 minutes). Jeffrey D. Horbar, M.D., and colleagues at the Vermont Oxford Network examined use of surfactant therapy by 114 neonatal intensive care units (NICUs), which treated 6,029 infants of 23-29 weeks gestation born in 2001.

Dr. Horbar and his colleagues randomly assigned 57 NICUs to a collaborative QI program, which included audit and feedback (that compared their administration and timing of surfactant and delivery room practice with peers), reviews of surfactant evidence, an interactive training workshop, and collaborative ongoing faculty support via conference calls and an E-mail discussion list. The other 57 control NICUs received center-specific confidential reports routinely prepared for members of the Vermont Oxford Network.

For more information, see "Collaborative quality improvement to promote evidence based surfactant for preterm infants: A cluster randomized trial," by Dr. Horbar, Joseph H. Carpenter, M.S., Jeffrey Buzas, Ph.D., and others, in the October 2004 British Medical Journal 329, pp. 1004-1010.

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