Structured implementation of a bubble-CPAP program to reduce bronchopulmonary dysplasia in preterm infants

Abstract

Abstract Background CPAP effectiveness may depend not only on the device itself, but also on implementation. We hypothesized that structured implementation would be associated with improved outcomes. This study describes a bubble-CPAP (b-CPAP) program—including training, guidelines, skills practice, and checklists—and evaluates its clinical correlates. Methods This study describes b-CPAP program implementation. The study included all preterm infants with birthweight <1500 g. Infants were excluded if gestational age <22 weeks, died in the delivery room before NICU admission, had genetic conditions or surgical conditions requiring transfer. Data were collected from January 2016 through December 2022. Outcomes before and after implementation were compared using bivariate and logistic regression analyses while adjusting for potential confounders. Results Among 903 infants, survival without BPD improved from 59% to 74% (aOR=1.86, 95% CI: 1.25–2.76, p = 0.01), and BPD rates decreased from 25.2% to 6.9% (aOR = 0.12, 95% CI:0.06–0.26, p < 0.001). Median oxygen use decreased from 26 (4–70) days to 15 (4–42) days ( p = 0.03), and CPAP use increased from 10 (5–19) days to 27 (10–39) days ( p < 0.0001). The incidence of pneumothorax did not change (4.1% to 6.4%, aOR = 1.59, 95% CI:0.80–3.18, p = 0.18). Conclusion Stepwise implementation of a structured b-CPAP program was associated with substantial improvements in survival without BPD and BPD rates. Impact Bronchopulmonary dysplasia (BPD) remains a major complication in premature infants, affecting approximately 40% of infants born under 1000 grams. While RCTs showed only modest benefit of early CPAP, observational studies reported greater improvements, underscoring the importance of consistent implementation beyond initial use. Structured stepwise implementation of the b-CPAP program was associated with improved survival without BPD and reduced BPD prevalence. The findings may inform future strategies to enhance reproducibility and effectiveness of CPAP use through systematic implementation.

Affiliated Institutions

• Cleveland Clinic US

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