Reducing Intervention and Length of Stay for Neonates With Transient Tachypnea of the Newborn

BACKGROUND AND OBJECTIVE: Transient tachypnea of the newborn (TTN) is a common respiratory disorder affecting late-preterm and term infants. Newborns with TTN are typically admitted to the neonatal intensive care unit (NICU) for medical care. Our objective was to reduce NICU length of stay (LOS) for patients with TTN by standardizing care to limit unnecessary intervention. METHODS: We used the Model for Improvement to implement interventions in our level III and IV NICUs and analyzed data using control charts. Interventions included consensus development/data review, clinical practice guideline implementation, case audits, and an electronic medical record (EMR) order set. Infants aged 35 weeks or more with TTN were included. The primary outcome measure was NICU LOS. Secondary outcome measures were time to first feed, time on respiratory support, incidence of peripheral intravenous (PIV) catheter placement, incidence of intravenous fluid (IVF) administration, incidence of hyponatremia, number of blood draws, and percentage of same-day birth parent-baby discharges. Balancing measures included NICU readmissions, percentage of patients with hypoglycemia, and exposure to breast milk during hospitalization. RESULTS: LOS decreased (90 to 51 hours) after study interventions. Time to first feed, time on respiratory support, incidence of hyponatremia, PIV placement, and IVF administration also decreased. Percentage of infants discharged home with their birth parent increased. No changes were noted in any balancing measures. CONCLUSION: By prioritizing clinical guideline development, case audits, and EMR implementations, this quality-improvement initiative resulted in decreased LOS and reduced medical interventions for infants with TTN admitted to a level III and level IV NICU.