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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >A cluster-randomized trial of benchmarking and multimodal quality improvement to improve rates of survival free of bronchopulmonary dysplasia for infants with birth weights of less than 1250 grams.
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A cluster-randomized trial of benchmarking and multimodal quality improvement to improve rates of survival free of bronchopulmonary dysplasia for infants with birth weights of less than 1250 grams.

机译：一项基准和多式联运的质量改善措施，以提高出生体重小于1250克的婴儿无支气管肺发育不良的生存率的集群随机试验。

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摘要

OBJECTIVE: We tested whether NICU teams trained in benchmarking and quality improvement would change practices and improve rates of survival without bronchopulmonary dysplasia in inborn neonates with birth weights of <1250 g. METHODS: A cluster-randomized trial enrolled 4093 inborn neonates with birth weights of <1250 g at 17 centers of the National Institute of Child Health and Human Development Neonatal Research Network. Three centers were selected as best performers, and the remaining 14 centers were randomized to intervention or control. Changes in rates of survival free of bronchopulmonary dysplasia were compared between study year 1 and year 3. RESULTS: Intervention centers implemented potentially better practices successfully; changes included reduced oxygen saturation targets and reduced exposure to mechanical ventilation. Five of 7 intervention centers and 2 of 7 control centers implemented use of high-saturation alarms to reduce oxygen exposure. Lower oxygen saturation targets reduced oxygen levels in the first week of life. Despite these changes, rates of survival free of bronchopulmonary dysplasia were all similar between intervention and control groups and remained significantly less than the rate achieved in the best-performing centers (73.3%). CONCLUSIONS: In this cluster-randomized trial, benchmarking and multimodal quality improvement changed practices but did not reduce bronchopulmonary dysplasia rates.
机译：目的：我们测试了在基准体重和质量改善方面经过培训的新生儿重症监护病房（NICU）小组是否会改变出生体重＜1250 g的新生儿而无支气管肺发育不良的做法并提高生存率。方法：一项整群随机试验在国立儿童健康与人类发展新生儿研究网络的17个中心招募了4093名出生体重<1250 g的新生儿。选择了三个中心作为最佳绩效中心，其余14个中心被随机分配到干预或控制中心。在研究的第1年和第3年之间比较了无支气管肺发育不良的存活率的变化。结果：干预中心成功实施了可能更好的实践。变化包括降低氧饱和度指标和减少机械通气暴露。 7个干预中心中的5个和7个控制中心中的2个实施了高饱和度警报，以减少氧气暴露。较低的氧饱和度目标降低了生命第一周的氧气水平。尽管有这些变化，干预组和对照组之间的无支气管肺发育不良的存活率都相似，并且仍然远低于表现最佳的中心所达到的比率（73.3％）。结论：在该整群随机试验中，基准测试和多模式质量改善改变了实​​践，但并未降低支气管肺发育不良率。

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