A Randomized Controlled Trial of Benchmarking to Reduce Bronchopulmonary Dysplasia

This study tested whether Neonatal Intensive Care Unit (NICU) teams trained in benchmarking - comparing care practices between different NICUs to see which practices prevent bronchopulmonary dysplasia (BPD) - and quality improvement would change practices and improve rates of survival without BPD in inborn neonates with birth weights of <1250 grams. Benchmarking is a method involving detailed comparisons of processes between similar organizations. For this study, three NRN centers with the lowest rates of BPD were identified as Benchmark centers. During a 6-month pre-intervention period, details of care practices and management style at these centers were carefully assessed. Based on practices at these Benchmarking sites, a quality improvement program was developed. A total of 14 other NRN sites were randomized to either implement the benchmarking intervention (intervention sites) or continue with their usual care practices (control sites). After the 1-year intervention period, changes in the rate of survival without BPD at 36 weeks corrected age were compared between the intervention and control sites. Intervention centers implemented potentially better practices successfully; changes included reduced oxygen saturation targets and reduced exposure to mechanical ventilation. Lower oxygen saturation targets reduced oxygen levels in the first week of life. Despite these changes, rates of survival free of BPD were all similar between intervention and control groups and remained significantly less than the rate achieved in the best-performing centers (73.3%).