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Specialist neonatal respiratory care for babies born preterm (NICE guideline 124): a review
  1. Anna Rodgers1,
  2. Cheentan Singh2
  1. 1 North Middlesex University Hospital NHS Trust, London, London, UK
  2. 2 Department of Paediatrics, North Middlesex University Hospital NHS Trust, London, UK
  1. Correspondence to Dr Anna Rodgers, North Middlesex University Hospital NHS Trust, London N18 1QX, UK; anna.rodgers2{at}nhs.net

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Background

Bronchopulmonary dysplasia (BPD) refers to abnormal postnatal lung development and is a significant cause of morbidity and mortality in premature babies.1 With advances in neonatal intensive care, survival rates of preterm infants are improving; however, the EPICure2 study showed no reduction in the incidence of BPD or other major morbidities from 1995 to 2006.2 Strategies used by neonatal units in all aspects of managing respiratory distress syndrome (RDS) may reduce the incidence of developing BPD and other adverse outcomes associated with prematurity.

Information about current guideline

This guideline was published in April 2019 by the National Institute for Health and Care Excellence (NICE).3 This is the first NICE guideline focusing on postnatal respiratory support of preterm infants. Respiratory support during immediate newborn resuscitation is addressed by the NICE accredited Resuscitation Council UK guidelines4 (box 1).

Box 1

Resources

  • Link to NICE guidance https://www.nice.org.uk/guidance/ng124

  • Link to NICE pathway (flowchart) https://pathways.nice.org.uk/pathways/specialist-neonatal-respiratory-care-in-preterm-babies

  • Link to Resuscitation Council UK ‘Resuscitation and support of transition of babies at birth’ https://www.resus.org.uk/resuscitation-guidelines/resuscitation-and-support-of-transition-of-babies-at-birth/

Key issues

Risk factors for developing BPD (table 1)

  • Surfactant treatment and treatment of a patent ductus arteriosus (PDA) are listed as risk factors as the need for treatment is likely to reflect the severity of the baby’s condition.

View this table:
Table 1

Identified risk factors for bronchopulmonary dysplasia

Ventilation strategies (box 2)

  • Delivery room: Continuous positive airway pressure (CPAP) is recommended instead of invasive ventilation, providing the baby has adequate respiratory drive.

  • Oxygen: Aim for oxygen saturations of 91%–95%. If more than 2 L/min of oxygen is required, humidified oxygen should be used.

  • Non-invasive ventilation: Either nasal CPAP or high-flow oxygen therapy (HFOT) can be used following stabilisation.

  • Invasive ventilation: Volume targeted ventilation (VTV) with synchronised ventilation should be first line. If VTV is …

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Footnotes

  • Contributors AR with support from CS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

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