Roll your own cigarettes are less natural and at least as harmful as factory rolled tobacco
Authors: R. Edwards
Journal: BMJ (2014)

<h3>Aims</h3> National Institute for Health and Care Excellence (NICE) in 2020 published the following 5 quality standards on specialist neonatal respiratory care for babies born preterm<sup>1</sup>: 1. Use of continuous positive airway pressure (CPAP) for preterm babies requiring respiratory support soon after birth and before admission to the neonatal unit, if clinically appropriate, rather than invasive ventilation. 2. Administration of surfactant via a minimally invasive technique, if invasive ventilation is not required. 3. Use of volume-targeted ventilation in combination with synchronised ventilation, if requiring invasive ventilation. 4. Target oxygen saturations of 91%-95% after stabilisation. 5. Parents and carers of preterm babies requiring respiratory support, are helped to care for their baby. Our aim was to review the care of preterm babies requiring respiratory support at the Royal Hampshire County Hospital (RHCH) and assess compliance with the new NICE standards between September 2019 and August 2020. <h3>Methods</h3> During the 12 month period, 83 preterm babies were born at the Royal Hampshire County Hospital (excluding admissions for non-respiratory causes e.g. jaundice). Of those 83 neonates, 7 were born &lt;28 weeks gestation, 18 babies were born between 28 and 31+6 weeks gestation, and the remaining 58 were born between 32 and 36+6 weeks gestation. 92% (n=76) of the preterm babies required a form of respiratory support during their neonatal admission. Using BadgerNet and medical notes, data regarding each NICE quality standard was collected for all 76 babies. Compliance against each standard was measured, with subgroup analysis by gestation. <h3>Results</h3> When transferring preterm babies to the neonatal unit who required respiratory support, CPAP was appropriate and used in all cases (100% compliance). LISA (less invasive surfactant administration) was introduced part way through the data collection period in 2019 and used in 2 out of 8 eligible babies (25% compliance) (see quality statement 2, figure 1). Invasive ventilation was always synchronised (100%), however volume-targeted ventilation in combination with synchronised ventilation was used in only 2 out of 12 eligible babies (16.7% compliance). Target oxygen saturation ranges were not routinely documented in the notes and therefore compliance was not calculatable. Parent involvement in day-to-day care was documented in 87% of the medical notes. The incidence of pneumothorax was 2.4% involving 2 babies born between 32 and 36+6 weeks, both requiring treatment for this. The incidence of bronchopulmonary dysplasia was diagnosed in 4 babies, who were all born before 32 weeks gestation and still required a form of respiratory support at 36 weeks gestation. <h3>Conclusion</h3> Compliance against standards varied between 16.7-100%. Some measures were difficult to quantify with the clinical datasets being previously recorded. Multiple improvements are already in place, including increased competencies in delivering LISA, regular simulation training, an educational guide on target oxygen saturations, better documentation of parental involvement, and a planned education package for volume-targeted ventilation. These changes will enable our standard practice to be in line with current NICE quality standards and a review of how relevant data is recorded, is also underway to support future audits. <h3>Reference</h3> Specialist neonatal respiratory care for babies born preterm QS193, NICE, (2020).