{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T20:44:33Z","timestamp":1785271473489,"version":"3.55.0"},"reference-count":14,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Our institutional data revealed high pneumothorax rates in term neonates resuscitated in the delivery room (DR). Other studies have reported that high rates of continuous positive airway pressure (CPAP) in the DR are associated with increased pneumothorax rates. We sought to test the hypothesis that quality improvement efforts to reduce the use of CPAP in the DR would be associated with a reduced incidence of pneumothorax.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n We performed a series of interventions to make minor revisions to our DR respiratory care algorithm focusing on optimizing CPAP use by providing education to the DR team to the revisions. For neonates born at 36 weeks of gestation or beyond, we evaluated the use of CPAP in the DR and the number of births between pneumothorax events before and after the algorithm was implemented. We used statistical process control charts to assess improvement.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n CPAP utilization in the DR for infants 36 weeks or older decreased from 3.4% to 1.0%. Frequency of pneumothorax decreased, with births between pneumothorax events increasing from 293 to 530. We found no increase in the number of neonates requiring a higher level of care with respiratory distress.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSION<\/jats:title>\n We found that a reduction in the use of CPAP in DR was associated with a decrease in the rate of pneumothorax without an increase in neonates requiring additional care with respiratory distress.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/peds.2023-064227","type":"journal-article","created":{"date-parts":[[2024,12,10]],"date-time":"2024-12-10T09:04:38Z","timestamp":1733821478000},"source":"Crossref","is-referenced-by-count":4,"title":["An Improvement Project to Lower Pneumothorax Rates in Neonates Born at 36 Weeks\u2019 Gestational Age or Beyond"],"prefix":"10.1542","volume":"155","author":[{"given":"Jenica","family":"Sandall","sequence":"first","affiliation":[{"name":"1Virginia Mason Franciscan Health, Tacoma, Washington"},{"name":"2Current affiliation: Washington State Hospital Association, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"Hilborn","sequence":"additional","affiliation":[{"name":"1Virginia Mason Franciscan Health, Tacoma, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Welty","sequence":"additional","affiliation":[{"name":"1Virginia Mason Franciscan Health, Tacoma, Washington"},{"name":"3The University of Washington School of Medicine, Department of Pediatrics, Division of Neonatal Medicine, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2024,12,10]]},"reference":[{"issue":"16_suppl_2","key":"2025101611114146600_r1","doi-asserted-by":"crossref","first-page":"S524","DOI":"10.1161\/CIR.0000000000000902","article-title":"Part 5: Neonatal resuscitation: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care","volume":"142","author":"Aziz","year":"2020","journal-title":"Circulation."},{"issue":"16_suppl_1","key":"2025101611114146600_r2","doi-asserted-by":"crossref","first-page":"S185","DOI":"10.1161\/CIR.0000000000000895","article-title":"Neonatal Life Support Collaborators. Neonatal life support: 2020 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations","volume":"142","author":"Wyckoff","year":"2020","journal-title":"Circulation."},{"issue":"2\u20133","key":"2025101611114146600_r3","first-page":"293","article-title":"Part 7: Neonatal resuscitation: 2015 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations","volume":"67","author":"International Liaison Committee on Resuscitation","year":"2005","journal-title":"Resuscitation."},{"issue":"18_suppl_3","key":"2025101611114146600_r4","doi-asserted-by":"crossref","first-page":"S909","DOI":"10.1161\/CIRCULATIONAHA.110.971119","article-title":"Part 15: Neonatal resuscitation: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care","volume":"122","author":"Kattwinkel","year":"2010","journal-title":"Circulation."},{"issue":"2","key":"2025101611114146600_r5","doi-asserted-by":"crossref","first-page":"157","DOI":"10.3233\/NPM-171694","article-title":"Delivery room continuous positive airway pressure and early pneumothorax in term newborn infants","volume":"10","author":"Clevenger","year":"2017","journal-title":"J Neonatal Perinatal Med."},{"issue":"3","key":"2025101611114146600_r6","doi-asserted-by":"crossref","first-page":"e20190756","DOI":"10.1542\/peds.2019-0756","article-title":"Delivery room continuous positive airway pressure and pneumothorax","volume":"144","author":"Smithhart","year":"2019","journal-title":"Pediatrics."},{"issue":"5","key":"2025101611114146600_r7","doi-asserted-by":"crossref","first-page":"F382","DOI":"10.1136\/archdischild-2014-307891","article-title":"Pulmonary air leak associated with CPAP at term birth resuscitation","volume":"100","author":"Hishikawa","year":"2015","journal-title":"Arch Dis Child Fetal Neonatal Ed."},{"key":"2025101611114146600_r8","volume-title":"Defining and Using Aims and Drivers for Improvement: A How-to Guide","author":"US Department of Health and Human Services Centers for Medicare & Medicaid Services Center for Medicare and Medicaid Innovation Learning and Diffusion Group","year":"2014"},{"key":"2025101611114146600_r9","volume-title":"The Health Care Data Guide: Learning From Data for Improvement","author":"Provost","year":"2011"},{"issue":"10","key":"2025101611114146600_r10","first-page":"CD001243","article-title":"Prophylactic or very early initiation of continuous positive airway pressure (CPAP) for preterm infants","volume":"10","author":"Subramaniam","year":"2021","journal-title":"Cochrane Database Syst Rev."},{"issue":"12","key":"2025101611114146600_r11","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1056\/NEJMoa1603694","article-title":"HIPSTER Trial Investigators. Nasal high-flow therapy for primary respiratory support in preterm infants","volume":"375","author":"Roberts","year":"2016","journal-title":"N Engl J Med."},{"issue":"6","key":"2025101611114146600_r12","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1038\/s41372-022-01334-4","article-title":"Decreasing delivery room CPAP-associated pneumothorax at \u226535-week gestational age","volume":"42","author":"Stocks","year":"2022","journal-title":"J Perinatol."},{"issue":"11","key":"2025101611114146600_r13","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1136\/bmjqs-2016-005526","article-title":"Comparison of control charts for monitoring clinical performance using binary data","volume":"26","author":"Neuburger","year":"2017","journal-title":"BMJ Qual Saf."},{"issue":"4","key":"2025101611114146600_r14","first-page":"CD013231","article-title":"Non-invasive respiratory support for the management of transient tachypnea of the newborn","volume":"4","author":"Moresco","year":"2020","journal-title":"Cochrane Libr."}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2023-064227\/1744984\/ped.2024-00029.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2023-064227\/1744984\/ped.2024-00029.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T15:11:50Z","timestamp":1760627510000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/155\/1\/e2023064227\/200192\/An-Improvement-Project-to-Lower-Pneumothorax-Rates"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,10]]},"references-count":14,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12,10]]},"published-print":{"date-parts":[[2025,1,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2023-064227","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,10]]},"article-number":"e2023064227"}}