{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T11:40:04Z","timestamp":1792842004488,"version":"4.5.0"},"reference-count":63,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,10,1]]},"abstract":"<jats:sec>\n                  <jats:title>BACKGROUND AND OBJECTIVES<\/jats:title>\n                  <jats:p>Many preterm infants stabilized on continuous positive airway pressure (CPAP) at birth require mechanical ventilation (MV) during the first 72 hours of life, which is defined as CPAP failure. Our objective was to decrease CPAP failure in infants \u226429 weeks\u2019 gestational age (GA).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>A quality improvement bundle named OPTISURF was implemented for infants \u226429 weeks\u2019 GA admitted on CPAP, consisting of stepwise escalation of CPAP and less invasive surfactant administration guided by fractional inspired oxygen concentration \u22650.3. The CPAP failure rate was tracked by using control charts. We compared practice and outcomes of a pre\u2013OPTISURF cohort (January 2017 to September 2018) to a post-OPTISURF cohort (October 2018 to December 2019).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Of the 216 infants \u226429 weeks\u2019 GA admitted to NICU on CPAP, 125 infants belonged to the pre-OPTISURF cohort (OSC) and 91 to the post-OSC. Compared with the pre-OSC, a higher proportion of infants in the post-OSC received CPAP 7 cm\u2009H2O within 4 hours of life (7% vs 32%; P &amp;lt; .01). The post-OSC also had lower rates of CPAP failure (54% vs 11%; P &amp;lt; .01), pneumothoraces (8% vs 1%; P &amp;lt; .03), need for MV (58% vs 31%; P &amp;lt; .01), and patent ductus arteriosus treatment (21% vs 9%; P = .02). Additionally, in a subgroup analysis, CPAP failure was lower in the post-OSC among infants 23 to 26 weeks (79% vs 27%; P &amp;lt; .01) and 27 to 29 weeks\u2019 GA (46% vs 3%; P &amp;lt; .01).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Implementation of a quality improvement bundle including CPAP optimization and less invasive surfactant administration decreased CPAP failure and need for MV in preterm infants.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2020-014191","type":"journal-article","created":{"date-parts":[[2021,9,22]],"date-time":"2021-09-22T08:25:10Z","timestamp":1632299110000},"source":"Crossref","is-referenced-by-count":20,"title":["Decreasing Continuous Positive Airway Pressure Failure in Preterm Infants"],"prefix":"10.1542","volume":"148","author":[{"given":"Venkatakrishna B.","family":"Kakkilaya","sequence":"first","affiliation":[{"name":"Division of Neonatal-Perinatal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather M.","family":"Weydig","sequence":"additional","affiliation":[{"name":"Division of Neonatal-Perinatal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William E.","family":"Smithhart","sequence":"additional","affiliation":[{"name":"Division of Neonatal-Perinatal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelly D.","family":"Renfro","sequence":"additional","affiliation":[{"name":"Parkland Hospital and Health System, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristi M.","family":"Garcia","sequence":"additional","affiliation":[{"name":"Parkland Hospital and Health System, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cari M.","family":"Brown","sequence":"additional","affiliation":[{"name":"Parkland Hospital and Health System, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"He","sequence":"additional","affiliation":[{"name":"Division of Neonatal-Perinatal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheron A.","family":"Wagner","sequence":"additional","affiliation":[{"name":"Parkland Hospital and Health System, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenn C.","family":"Metoyer","sequence":"additional","affiliation":[{"name":"Parkland Hospital and Health System, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. 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