Standardized Management of Persistent Pulmonary Hypertension in the Neonate
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Persistent pulmonary hypertension is a well-described phenomenon that results in elevated pulmonary vascular resistance and delayed transition to adult circulation. Many treatment modalities exist, with the final option being extracorporeal membrane oxygenation, which is fraught with morbidity and mortality. Most treatment modalities are widely accepted, although evidence-based clinical practice guidelines were not published until 2022. The quantitative quasi-experimental evidence-based quality improvement project aimed to determine if the evidence-based persistent pulmonary hypertension management intervention decreases outbound transfer in infants greater than or equal to 34 weeks gestation with persistent pulmonary hypertension from a level III neonatal intensive care unit to a level IV neonatal intensive care unit. A total of 15 infants were included in the project: 11 in the pre-protocol group and 4 in the post-protocol intervention group at a hospital in the Midwest. Outcomes measured were outbound transfer and length of stay at either institution. The project was not powered to meet statistical significance, but the transfer rate decreased from 60% to 25%, which may be clinically significant. Consistent, evidence-based management can reduce the time to medical stability, decrease outbound transfers, and preserve revenue for the birth hospital.
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Open Access (fully available)