How do neonatal units within the Australian and New Zealand Neonatal Network manage ex‐preterm infants with severe chronic lung disease still requiring major respiratory support at term?

Abstract

Aim The aim was to survey the Australian and New Zealand Neonatal Network (ANZNN) member units regarding current services and management guidelines for the ex‐premature infant with severe chronic lung disease (CLD) still requiring significant respiratory support at term. Methods A 16‐question survey was sent to clinical directors of all Level 3 units in Australia and New Zealand via the network. Reminder emails were sent, as required, to prompt a satisfactory response rate. Results Survey responses were received from 26 of the 29 (90%) ANZNN Level 3 units. At 37 weeks' corrected gestation, over 90% of the units provide ongoing respiratory support in the neonatal intensive care unit (NICU). However, by 50 weeks, ongoing care is provided in several settings, including NICU, high dependency unit (HDU)/paediatric intensive care unit or respiratory wards. The majority (76%) of units arrange transfer on an ad hoc basis, but six units (24%) have set criteria for transfer based on gestation, workload and respiratory requirement. Three units declared a maximum age in NICU (44, 46 or 48 weeks). A variety of approaches were used to identify infants who were likely to require transfer, and 78% of units had a staff member assigned to assist transition. Three units stated that they had a home ventilation programme suitable for these infants. No unit supplied a guideline on tracheostomy or specific respiratory management post‐term. Conclusion Despite a significant number of babies requiring ongoing support for severe CLD, the location of the service appears very variable, and there is a lack of specific written guidelines.

Chronic respiratory failure in bronchopulmonary dysplasia

“…Programs in both advanced and developing countries have described the discharge process for children who are chronically‐ventilated via tracheostomy at home 43,49‐57 . Attempts are made to follow the most recent evidenced‐based guidelines from the American Thoracic Society (ATS), 58 the United Kingdom, 59 and the Australian Pediatric Respiratory Group 60 .…”