Nutritional Follow-up of Newborns with Bronchopulmonary Dysplasia (BPD)
Low birth weight and extremely low birth weight infants experience growth failure during their stay in the Neonatal Intensive Care Unit (NICU). The average weight at 40 weeks Corrected Gestational Age (CGA) is significantly below the 10th percentile. Growth in infants with bronchopulmonary dysplasia (BPD) is more severely affected. This growth failure is associated with lesser neurodevelopmental outcomes. Catch- up weight by 48 CGA is associated with improved neurodevelopmental outcomes. However, this can be quite challenging as those infants with BPD have increased metabolic rates and require sufficient protein in order to grow well.
This project examined the post-discharge growth failure rate before (baseline = Phase I) and after (Phase II) the implementation of a multidisciplinary clinic specifically for infants discharged with active BPD which was staffed by a single neonatologist and neonatal nurse practitioner (NP). Prior practice was to have the pulmonary issues of the infants monitored by the pediatric pulmonary group and nutritional issues were not specifically addressed during this period except by the general pediatrician. For the third phase of the project, the intervention included a neonatal dietician in the post-discharge evaluation and care of the patients when they came to the clinic. The project aimed to decrease the growth failure rate in infants with BPD who attend this clinic.
MOC Project Director
Ted Rosenkrantz, MD
Procedural Sedation Quality and Safety Improvement Initiative
The project sought to identify the complications associated with procedural sedation at Connecticut Children’s Medical Center (CCMC), calculate the incidence of those complications and compare those rates to those benchmarked in the literature by members of the Society for Pediatric Sedation (SPS) and Pediatric Sedation Research Consortium (PSRC). Procedural sedation has become a topic of concern for the Joint Commission and the Center for Medicare Services, their involvement prompted our initial engagement in this review. The ultimate goal was to ensure that procedural sedation at CCMC was of the highest quality and as safe as or safer than sedation rendered at other national or international Children’s Hospitals.
Our institutional goal was to improve access, efficacy and safety for procedural sedation. Based on the 2008 data, we sought to decrease the incidence of inadequate sedation in the Dental and Audiology/EEG areas by 3% (to 6% in Dental and to 3% in Audiology/EEG) for the 2010 calendar year while maintaining safety (i.e., not increasing other complications during sedation such as apnea or hypoxia). A further decrease of 2-3% in 2011 was targeted (to 3% in Dental and 1% in Audiology/EEG) with a sustained rate of 1-2% in the ensuing years (2011-2012).
MOC Project Director
David Marcello, MD