Improving Adherence to Postneonatal Pulmonary Hypertension Screening Guidelines in Very Low Birth Weight Infants: A Quality Improvement Initiative

Background/Objectives: Postneonatal pulmonary hypertension (PNPH) (PH presenting after day 14 of age) or late-onset pulmonary hypertension (PH) is more common as the severity of bronchopulmonary dysplasia (BPD) increases. It is associated with increased mortality. Consensus guidelines have recommended screening for PH in babies with BPD. Using these guidelines, we developed a screening protocol and management algorithm for PNPH. At our institution, only 20% of eligible infants had PH appropriately specified as the indication for screening echocardiography. This quality improvement (QI) initiative aimed to increase adherence to a standardized PNPH screening guideline from 20% to 80% by 2021.

Methods

Screening focused on infants < 1500 g who remained on any form of respiratory support at 28 days of life or at 34–36 weeks postmenstrual age. We used the Model for Improvement and iterative Plan-Do-Study-Act cycles incorporating provider education, standardized screening algorithms, multidisciplinary engagement, and weekly clinical reminders to improve adherence to the PNPH screening guideline.