Effect of a Silverman-Andersen Respiratory Severity Score-based CPAP Weaning Algorithm on Newborn CPAP Duration

Sierra Arbaugh*, Audrey N. Miller, Alicia A. Moise, Tara N. Morder, Matthew Ezzi, Lesley Cottrell, and Stephen M. Akers

Neonatal Intensive Care Unit, Ruby Memorial Hospital, West Virginia University, Morgantown, WV 26505

Presentation Category: Health Sciences (Poster Presentation #112)

Student’s Major: Nursing

Background: Newborns who experience respiratory problems often require breathing support and admission to neonatal intensive care units (NICUs). Many of these infants are supported with continuous positive airway pressure (CPAP) devices. While initially needed, CPAP is not a benign intervention, especially when used longer than necessary. This study evaluated the impact of a weaning algorithm on the duration of CPAP use for newborns in the NICU. Methods: We performed a retrospective chart review after implementing an algorithm to guide CPAP weaning and discontinuation based on the Silverman-Andersen respiratory severity score. Two time periods were compared to evaluate outcomes: December 2018 – June 2019 and January 2020 – June 2020. Following data analysis, a quality control audit was performed to determine correct algorithm use. Results: There were no differences in the duration of CPAP, time to first oral feed, or length of hospital stay. There was less supplemental oxygen use and more infants returned to room with their mothers in the post-algorithm period. Quality-control audits revealed that the algorithm was followed correctly in 32% of cases with the duration of CPAP, on average, 11h less than cases when used incorrectly. Conclusion: An algorithm to guide weaning CPAP in newborns with respiratory problems did not reduce CPAP duration. However, the algorithm was used correctly in one-third of cases. When used correctly, the algorithm may result in shorter CPAP duration and improvement in other outcomes. Moving forward, quality-control meetings will be implemented to share these findings and provide education about correct algorithm use.

Funding:

Program/mechanism supporting research/creative efforts: WVU's Research Apprenticeship Program (RAP) & accompanying HONR 297-level course