5: Impact of Open Lung Strategy on the Neonatal Outcomes in Preterm Infants
Bibliographic record
Abstract
Our aim was to reduce bronchopulmonary dysplasia (BPD) at Foothills Medical Center (FMC), which had one of the highest rates among Canadian NICUs. We developed evidence-based practice guidelines called Open Lung Strategy (OLS), to help maintain functional residual capacity with distending pressures. To examine the impact of ‘open lung strategy’ on short term neonatal outcomes among preterm infants with gestational age <33 weeks. This is retrospective cohort study. In October 2011, OLS was implemented through multidisciplinary meeting, use of checklist and quarterly feedback to the neonatal group. We included all infants with gestational age <33 weeks. The pre-OLS group included infants admitted between July 2010 and Sept 2011 and the post-OLS group were those admitted between Oct 2011 to Dec 2012. Neonatal outcomes between the two groups were analyzed using univariate and multivariate analysis. The primary outcome was bronchopulmonary dysplasia (BPD) at 36 weeks postmenstrual age. Secondary outcomes included intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP) and necrotizing enterocolitis (NEC). Of the 792 eligible infants, 396 were admitted in post OLS study period. No significant differences were observed in the baseline characteristics between the two groups. On univariate analysis, BPD and ROP ≥ stage3 was significantly reduced in post OLS group. However, IVH was significantly increased in the Post OLS group. The implementation of a practice change targeting a respiratory management strategy resulted in reduced rates of BPD. There was an associated decrease in ROP and increase in IVH the secondary outcomes. A longer period of study will determine if the improvement in BPD and ROP is sustained and if the change in IVH is a true increase. When quality improvement strategies are implemented comprehensive disease free survival should be studied.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".