Rates of Bronchopulmonary Dysplasia Following Implementation of a Novel Prevention Bundle.

Importance: Bronchopulmonary dysplasia (BPD) rates in the United States remain high and have changed little in the last decade.

Objective: To develop a consistent BPD prevention bundle in a systematic approach to decrease BPD.

Design, Setting, and Participants: This quality improvement study included 484 infants with birth weights from 501 to 1500 g admitted to a level 3 neonatal intensive care unit in the Kaiser Permanente Southern California system from 2009 through 2019. The study period was divided into 3 periods: 1, baseline (2009); 2, initial changes based on ongoing cycles of Plan-Do-Study-Act (2010-2014); and 3, full implementation of successive Plan-Do-Study-Act results (2015-2019).

Interventions: A BPD prevention system of care bundle evolved with a shared mental model that BPD is avoidable.

Main Outcomes and Measures: The primary outcome was BPD in infants with less than 33 weeks' gestational age (hereafter referred to as BPD