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  • Quality Improvement Article
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A quality improvement initiative to reduce antibiotic use in transient tachypnea of the newborn

Journal of Perinatology volume 44, pages 119–124 (2024)Cite this article

Subjects

Abstract

Objective

Evidence suggests that antibiotics are unnecessary in infants with transient tachypnea of the newborn (TTN) that are low-risk for early-onset sepsis. The aim was to reduce ampicillin and gentamicin days of therapy (DOT) in infants with suspected TTN by 10% within 12 months.

Study design

We used the Model for Improvement to test interventions from August 2019 to September 2021 to decrease antibiotic utilization in low-risk infants with TTN. Interventions included the creation of an evidence-based clinical pathway, admission huddles, and prescriber audit and feedback.

Results

We reduced ampicillin and gentamicin use by 26% and 23%, respectively. In 123 infants with suspected TTN, we sequentially decreased starting antibiotics in this group from 71% to 41%, 13% and 0%. There were no cases of missed bacteremia.

Conclusion

Creation of a multidisciplinary antimicrobial stewardship QI team and subsequent interventions were successful in safely reducing antibiotic use in infants with TTN.

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Fig. 1: Key driver diagram for reducing antimicrobial use in a level IV NICU.
Fig. 2: U' charts displaying monthly ampicillin and gentamicin DOT per 1000 patient days present.
Fig. 3: U’-chart displaying monthly DOT for all antimicrobials per 1000 patient days present.
Fig. 4: P-chart displaying the percent of infants ≥35 weeks with a presumed diagnosis of TTN started on antibiotics.

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Acknowledgements

We thank all the members of this ASP QI initiative, and the attending, fellow, NP, RN, and clinical pharmacy staff in the Alexandra Cohen NICU at NYP-Weill Cornell for their dedication and enthusiasm for antimicrobial stewardship.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, NewYork Presbyterian-Weill Cornell Medicine, New York, NY, USA

    Liana Senaldi, Lauren Blatt, Giselle Gozum, Susan L. Venturini, Sherrie Hauft, Vivien Yap & Priyanka Tiwari

  2. Department of Pediatrics, Division of Pediatric Infectious Diseases, NewYork Presbyterian-Weill Cornell Medicine, New York, NY, USA

    Jin-Young Han & Karen P. Acker

  3. Department of Pediatrics, NewYork Presbyterian-Weill Cornell Medicine, New York, NY, USA

    Snezana Nena Osorio

Authors
  1. Liana Senaldi
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  2. Lauren Blatt
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  3. Jin-Young Han
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  4. Giselle Gozum
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  5. Susan L. Venturini
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Contributions

LS assisted with study design, performed data collection and preparation, analyzed the data, drafted the initial manuscript, and critically reviewed and revised the manuscript. LB, GG, and SV assisted with data collection and critically reviewed the manuscript. JH, SH, VY, and KA contributed to study design and critically reviewed the manuscript. SO assisted with data analysis and preparation and critically reviewed the manuscript. PT conceptualized and designed the study, performed data collection and preparation, analyzed the data, and critically reviewed and revised the manuscript. All authors reviewed and approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Liana Senaldi.

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Competing interests

The authors declare no competing interests.

Ethics approval

The Weill Cornell Medicine Institutional Review Board (IRB) approved this study with a waiver of informed consent, and it was considered exempt by the IRB since it represented QI.

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Senaldi, L., Blatt, L., Han, JY. et al. A quality improvement initiative to reduce antibiotic use in transient tachypnea of the newborn. J Perinatol 44, 119–124 (2024). https://doi.org/10.1038/s41372-023-01850-x

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