Chronic Lung Disease, also known as Bronchopulmonary Dysplasia, is a lung disease of extreme prematurity. A preterm baby has very fragile and underdeveloped lungs. Unfortunately, the things done to keep a tiny baby alive can sometimes cause damage to lungs. There are, however, potentially better practices, that can be implemented that can decrease the risk of this happening. TIPQC has launched this project so that Tennessee’s Tiniest Babies can have the best chance possible in avoiding this problem.

The TIPQC Prevention of Chronic Lung Disease (CLD) Improvement Project is the second project under the Tennessee Tiniest Babies Bundle with the project aim of a 25% relative reduction (over last 3 years institutional baseline) in chronic lung disease and a 10% relative reduction in Grade 3 Bronchopulmonary dysplasia (BPD) in infants less than or equal to 29.6 weeks gestational age in participating TN NICUs by June 2025.  This project was open to all level 3 and 4 NICUs across the state who care for infants <32 weeks and a birth weight <1500g.

While advances in neonatal care have significantly improved ELBW survival, BPD rates have not improved. Multiple factors contribute to CLD including mechanical ventilation, oxygen toxicity, infection, inflammation, and preventing secondary lung injury. Collectively, improvements in these areas can reduce morbidity and mortality in preterm infants. Quality improvement (QI) projects focused on the implementation of potentially better practices have demonstrated that single institutions and even collaborative efforts can decrease the incidence of CLD.

In 2020, 1,352 babies, or 1.7% of live births, were born very preterm in Tennessee and cared for at these facilities. Statistically, this group of infants represents approximately one-third of our state’s infant deaths. To lower Tennessee’s infant mortality rate, meet the goal as put forth in the “2030 Healthy People” objectives, thus improving care and outcomes, a collaborative approach to the care along with the implementation of effective care strategies will be realized through this bundle.

During the project, which began in the Spring of 2024 and moved to sustainment June 2025, 10 Level Ill and IV Neonatal Intensive Care Units (NICUs) from across Tennessee worked to achieve a 25% relative reduction (facility’s previous 3-year baseline) in CLD in this population, as well as an overall 25% reduction in mortality.

All hospitals were able to achieve or maintain a decrease in Grade 3 CLD. Participating hospitals reported no death due to CLD during the project.  With 672 infants across the state in this project, this is the equivalent of 17 premature babies who survived that would not have the previous year.

Two (2) hospitals achieved a Platinum QI rating which consisted of active project participation including huddles and coaching calls, monthly outcome and structure data capture, data-driven QI work, clinical change implementation, and decreasing the rates of CLD as well as decreasing CLD mortality:

• East Tennessee Children’s Hospital
• Regional One Health

Five (5) hospitals received a Gold QI Rating, having achieved 7 out of 8 of the above criteria, which included:

• Baptist Memorial Hospital for Women
• Methodist LeBonheur Germantown Hospital
• Parkridge East Hospital
• TriStar Centennial Medical Center
• University of Tennessee Medical Center, Knoxville
• Niswonger Children’s Hospital

Silver QI Ratings, having achieved at least 5 out of the 8 above criteria include:

• Jackson-Madison County General Hospital
• Monroe Carell Jr. Children’s Hospital

All hospitals improved care to reduce CLD. Congratulations to all the teams!

TIPQC is proud to have these teams of healthcare professionals and parents participate in this very important project.   This project, like so many of the other TIPQC projects, is aimed at improving care for babies and families one project at a time.

USING THIS INTERACTIVE DASHBOARD, CLICK ON THE FIELDS BELOW TO REVIEW THIS PROJECT’S PROGRESS ON KEY PROCESS, STRUCTURE, AND OUTCOME MEASURES.