Respiratory Management of Extremely Preterm Infants: An International Survey

Abstract

Background: There are significant international variations in chronic lung disease rates among very preterm infants yet there is little data on international variations in respiratory strategies. Objective: To evaluate practice variations in the respiratory management of extremely preterm infants born at < 29 weeks’ gestational age (GA) among 10 neonatal networks participating in the International Network for Evaluating Outcomes (iNeo) of Neonates collaboration. Methods: A web-based survey was sent to the representatives of 390 neonatal intensive care units from Australia/New Zealand, Canada, Finland, Illinois (USA), Israel, Japan, Spain, Sweden, Switzerland, and Tuscany (Italy). Responses were based on practices in 2015. Results: Overall, 321 of the 390 units responded (82%). The majority of units within networks (40–92%) mechanically ventilate infants born at 23–24 weeks’ GA on continuous positive airway pressure (CPAP) with 30–39% oxygen in respiratory distress within 48 h after birth, but the proportion of units that offer mechanical ventilation for infants born at 25–26 weeks’ GA at similar settings varied significantly (20–85% of units within networks). The most common respiratory strategy for infants born at 27–28 weeks’ GA on CPAP with 30–39% oxygen with respiratory distress within 48 h after birth used by units also varied significantly among networks: mechanical ventilation (0–60%), CPAP (3–82%), intubation and surfactant administration with immediate extubation (0–75%), and less invasive surfactant administration (0–68%). Conclusions: There are marked variations but also similarities in respiratory management of extremely preterm infants between networks. Further collaboration and exploration is needed to better understand the association of these variations in practice with pulmonary outcomes.

Trends in Outcomes for Neonates Born Very Preterm and Very Low Birth Weight in 11 High-Income Countries

“…Respiratory management, including avoidance of mechanical ventilation, is practiced widely; however, postextubation management is variable between both countries and units within countries. 17 Evidence for simultaneous administration of steroid and surfactant has recently emerged; therefore, the practice was not in use in any country 2015. Future studies are needed to determine which management factors are associated with non-improvement or increases in BPD rates.…”

“…11 Previously, we reported a significant variation in outcomes between the participating iNeo countries 16 as well as differences in some practices. [17][18][19][20][21] In this study, our aim was to analyze trends in the health outcomes of neonates born very preterm in 11 highincome countries. The impetus for this comparison came from iNeo objectives to understand variation, foster discussion and collaboration, and identify areas for improvement through the assessment of changes in neonatal outcomes within countries over time.…”

Composite neonatal morbidity indicators using hospital discharge data: A systematic review

“…Associating procedure codes with diagnoses was used to address over‐coding bias, as procedure codes are generally more accurate than diagnosis codes . However, this latter approach may measure medical practices, known to vary across hospitals and countries, more than newborn health …”

Information technology infrastructure, quality improvement and research: the UK National Neonatal Research Database

“…The NNRD is also the UK data source for international collaborations. The International Network for Evaluation of Outcomes of Neonates (iNeo) is a quality improvement project based on collaborative comparisons of population-based international healthcare for neonates led by the University of Toronto (http://ineonetwork.org) (28) that has produced a number of outputs (29)(30)(31)(32)(33)(34)(35)(36)(37)(38). eNewborn is a pan-European preterm benchmarking platform (39).…”