Improving Adherence to Postneonatal Pulmonary Hypertension Screening Guidelines in Very Low Birth Weight Infants: A Quality Improvement Initiative

Background/Objectives: Postneonatal pulmonary hypertension (PNPH) (PH presenting after day 14 of age) or late-onset pulmonary hypertension (PH) is more common as the severity of bronchopulmonary dysplasia (BPD) increases. It is associated with increased mortality. Consensus guidelines have recommended screening for PH in babies with BPD. Using these guidelines, we developed a screening protocol and management algorithm for PNPH. At our institution, only 20% of eligible infants had PH appropriately specified as the indication for screening echocardiography. This quality improvement (QI) initiative aimed to increase adherence to a standardized PNPH screening guideline from 20% to 80% by 2021. Methods: Screening focused on infants < 1500 g who remained on any form of respiratory support at 28 days of life or at 34–36 weeks postmenstrual age. We used the Model for Improvement and iterative Plan-Do-Study-Act cycles incorporating provider education, standardized screening algorithms, multidisciplinary engagement, and weekly clinical reminders to improve adherence to the PNPH screening guideline. Results: Among 118 eligible infants, appropriate screening adherence increased from 20% to 60%, although the predefined 80% target was not achieved. Screening completion at 34–40 weeks increased from 78% to 95%, without an increase in overall echocardiography utilization. In secondary descriptive analyses, 35% of eligible infants had mild-to-moderate PH on screening echocardiography, while 8% subsequently required pulmonary vasodilator therapy. Only one infant was identified and treated solely through routine screening. Conclusions: Implementation of a standardized PNPH screening guideline improved screening adherence without increasing echocardiography utilization, although the predefined QI target was not achieved. These findings support the feasibility of structured PNPH screening in the NICU and highlight opportunities for further improvement. Secondary clinical observations warrant evaluation in larger studies.