This report describes a quality-improvement initiative aimed at reducing interventions and NICU LOS for neonates diagnosed with Transient tachypnea of the newborn (TTN) admitted to level III and IV neonatal intensive care units. The project prioritized standardization of care to limit unnecessary procedures and support earlier discharge when clinically appropriate.
TTN is a common respiratory condition in late-preterm and term infants. Newborns with TTN are frequently admitted to NICUs for monitoring and supportive care. The stated objective of this initiative was to decrease NICU length of stay for infants with TTN by standardizing clinical care and reducing unnecessary interventions.
The improvement team used the Model for Improvement framework to plan and implement changes. Interventions included establishment of multidisciplinary consensus and regular data review, development and implementation of a clinical practice guideline, ongoing case audits, and creation of an electronic medical record (EMR) order set tailored to the guideline. Data were analyzed with control charts to track change over time and assess impact.
Infants included in the project met the following criterion: gestational age 35 weeks or greater with a diagnosis of TTN. The work was carried out across level III and level IV NICUs affiliated with the authors’ institutions.
The primary outcome measure was NICU length of stay (LOS). Secondary outcome measures comprised:
Balancing measures monitored for unintended consequences included NICU readmissions, percentage of patients with hypoglycemia, and exposure to breast milk during hospitalization.
Following implementation of the described interventions, the project observed a reduction in the primary outcome: NICU LOS decreased from 90 hours to 51 hours. Several secondary measures also improved: time to first feed and time on respiratory support both decreased. The incidences of hyponatremia, PIV placement, and IVF administration were reduced, and the number of blood draws declined. Additionally, the percentage of infants discharged home with their birth parent on the same day increased.
The findings suggest that standardizing care pathways and integrating guideline-based order sets into the EMR can reduce both length of hospitalization and the frequency of select medical interventions for infants with TTN.
No changes were detected in the monitored balancing measures. Specifically, there were no reported increases in NICU readmissions, no increase in the percentage of patients experiencing hypoglycemia, and no detrimental change in exposure to breast milk during the hospitalization. These observations indicate that the reductions in LOS and interventions were not associated with the balancing harms tracked by the project.
The quality-improvement initiative demonstrated that prioritizing clinical guideline development, routine case audits, and targeted EMR implementations was associated with meaningful reductions in NICU LOS and in several medical interventions for neonates with TTN admitted to level III and IV NICUs. The project reported no adverse signals in prespecified balancing measures.
These results support the potential utility of a structured, guideline-driven approach combined with EMR order sets to standardize care, limit unnecessary interventions, and shorten hospitalization for infants with TTN. Specific numeric outcomes reported by the authors include a decrease in median LOS from 90 hours to 51 hours; other improvements were described qualitatively in the abstract (decreases in time to first feed, time on respiratory support, hyponatremia, PIV placement, and IVF administration) but numeric values for those measures were not provided in the abstract.
Note: details beyond what appears in the published abstract, including granular numeric results, statistical testing, or timelines for implementation cycles, were not reported in the source abstract and therefore are not included here.