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Specialist neonatal respiratory care in preterm babies

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What is covered

This interactive flowchart covers specialist neonatal respiratory care in preterm babies.

Updates

Patient-centred care

Parents and carers have the right to be involved in planning and making decisions about their baby's health and care, and to be given information and support to enable them to do this, as set out in the NHS constitution and summarised in making decisions about your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Short Text

Everything NICE has said on specialist neonatal respiratory care in preterm babies in an interactive flowchart

What is covered

This interactive flowchart covers specialist neonatal respiratory care in preterm babies.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Neonatal specialist care (2010) NICE quality standard 4

Quality standards

Quality statements

Care pathways and guidelines

This quality statement is taken from the neonatal specialist care quality standard. The quality standard defines clinical best practice in neonatal specialist care and should be read in full.

Quality statement

In-utero and postnatal transfers for neonatal special, high-dependency, intensive and surgical care follow perinatal network guidelines and care pathways that are integrated with other maternity and newborn network guidelines and pathways.

Quality measure

Structure
(a) Evidence of perinatal network guidelines and care pathways for in-utero and postnatal transfers for neonatal special, high-dependency, intensive and surgical care.
(b) Evidence that perinatal network guidelines and care pathways for in-utero and postnatal transfers for neonatal special, high-dependency, intensive and surgical care, are integrated with other maternity and newborn network guidelines and pathways.
(c) Evidence of network arrangements to ensure that when a baby is admitted to specialist neonatal care, the mother and any multiple birth siblings can be accommodated in the same hospital during their respective admissions.
Process
(a) Proportion of babies born at less than 28 weeks of gestation who receive intensive care in a neonatal intensive care unit (NICU) within the network.
Numerator: the number of babies receiving intensive care in a NICU within the network.
Denominator: the number of babies born at less than 28 weeks of gestation within the network.
(b) Proportion of babies with antenatally diagnosed fetal malformations requiring early surgery who are delivered at a designated network surgical centre.
Numerator: the number of babies delivered at a designated network surgical centre.
Denominator: the number of babies born within the network with antenatally diagnosed fetal malformations requiring early surgery.
(c) Proportion of babies who are transferred back to their local neonatal unit within 24 hours of request for repatriation.
Numerator: the number of babies transferred within 24 hours of repatriation request.
Denominator: the number of babies transferred back to their local neonatal unit.
(d) Proportion of babies who require neonatal surgery who receive it at a designated network surgical centre.
Numerator: the number of babies undergoing surgery at a designated network surgical centre.
Denominator: the number of babies born within the network who require neonatal surgery.
(e) For singleton births: proportion of mothers who still require inpatient care when their baby is transferred to specialist neonatal care, who are transferred to the same hospital as their baby.
Numerator: the number of mothers transferred to the same hospital as their baby.
Denominator: the number of mothers who still require inpatient care when their baby is transferred to specialist neonatal care.
(f) For multiple births: proportion of babies transferred to specialist neonatal care whose mother and/or multiple birth siblings are transferred to the same hospital if still requiring inpatient care.
Numerator: the number of babies whose mother and/or multiple birth siblings are transferred to the same hospital.
Denominator: the number of babies from multiple births transferred to specialist neonatal care whose mother and/or multiple birth siblings still require inpatient care.

What the quality statement means for each audience

Service providers ensure perinatal network guidelines and care pathways for transfers for neonatal special, high-dependency, intensive and surgical care are implemented and integrated with other maternity and neonatal guidelines and pathways. Ensure regular monitoring of operation and effectiveness.
Healthcare professionals ensure perinatal network guidelines and care pathways are followed when transferring babies for neonatal special, high-dependency, intensive and surgical care, and invoke a report or alert mechanism where this is not possible.
Commissioners and networks ensure all eligible patients within their health economy are covered by perinatal network guidelines and care pathways for transfer for special, high-dependency, intensive and surgical care.
Parents of babies transferred to neonatal special, high-dependency, intensive or surgical care can expect the transfer to be in line with network guidelines and care pathways. These guidelines and care pathways describe specific procedures about safely transferring babies to other hospitals.

Definitions

The Department of Health toolkit (2009) defines a network as ‘linked groups of health professionals and organisations from primary, secondary and tertiary care, working in a coordinated manner, unconstrained by existing professional and health board boundaries, to ensure equitable provision of high-quality, clinically effective services.'
Guidance on the content of guidelines and pathways can be found within the Department of Health toolkit (2009) under Principles 4 and 7.

Data source

Structure
Local and network data collection.
Process
Local and network data collection.

Annual needs assessments

This quality statement is taken from the neonatal specialist care quality standard. The quality standard defines clinical best practice in neonatal specialist care and should be read in full.

Quality statement

Networks, commissioners and providers of specialist neonatal care undertake an annual needs assessment and ensure each network has adequate capacity.

Quality measure

Structure
Evidence of an annual needs assessment including production of an annual report covering, as a minimum, specialist neonatal activity for the network's population, monitoring of quality metrics and how concerns are being addressed.
Process
(a) Proportion of mothers whose babies required specialist neonatal care and who were booked to deliver in the network who received all their perinatal care within the network area (standard 95% as per Department of Health toolkit [2009]).
Numerator: the number of mothers receiving all their perinatal care within the network area.
Denominator: the number of mothers whose babies required specialist neonatal care and who were booked to deliver in the network area.
(b) Proportion of babies who receive specialist neonatal care in the network who are from outside the network area.
Numerator: the number of babies from outside the network area.
Denominator: the number of babies receiving specialist neonatal care in the network.
(c) Bed occupancy for each level of care (standard 80% as specified in the Department of Health toolkit [2009]).

What the quality statement means for each audience

Service providers cooperate with networks and commissioners to carry out an annual specialist neonatal care needs assessment. If service provision levels are found to be inadequate, they ensure action is taken in conjunction with commissioners.
Healthcare professionals assist with specialist neonatal care needs assessments by providing accurate and validated data.
Commissioners and networks ensure that, in conjunction with service providers, an annual specialist neonatal care needs assessment is undertaken. In addition, they clearly define expected levels of service provision.
Parents of babies receiving specialist neonatal care can expect that the needs of their baby will be met by services provided in their area.

Definitions

Quality metrics are defined further in the Department of Health toolkit (2009) section 5.

Data source

Structure
Local and network data collection.
Process
a) Local and network data collection. Contained within the Royal College of Paediatrics and Child Health National Neonatal Audit Programme.
b) Royal College of Paediatrics and Child Health National Neonatal Audit Programme collects data on whether all babies who access neonatal services are treated following their own neonatal network clinical pathway.
c) Local and network data collection.

Skilled and multidisciplinary staff

This quality statement is taken from the neonatal specialist care quality standard. The quality standard defines clinical best practice in neonatal specialist care and should be read in full.

Quality statement

Specialist neonatal services have a sufficient, skilled and competent multidisciplinary workforce.

Quality measure

Structure
(a) Evidence of local arrangements to ensure specialist neonatal staff are compliant with competency levels as described by the Department of Health toolkit (2009).
(b) Evidence of local arrangements to provide a multidisciplinary service, trained and competent in the care of neonates, that has access to:
  • specialist neonatal or paediatric dietitians
  • specialist neonatal occupational therapists
  • specialist neonatal physiotherapists
  • specialist neonatal speech and language therapists
  • specialist neonatal pharmacists.
Process
Proportion of completed specialist neonatal care shifts with the correct nursing and medical staffing levels as specified in the Department of Health toolkit (2009).
Numerator: the number of shifts with the correct nursing and medical staffing levels as specified in the Department of Health toolkit (2009).
Denominator: the number of completed specialist neonatal care shifts.

What the quality statement means for each audience

Service providers ensure specialist neonatal services are staffed in accordance with the Department of Health toolkit (2009), and that training and competencies are regularly reviewed.
Healthcare professionals ensure they are skilled and competent for their roles and responsibilities by accessing appropriate training.
Commissioners ensure that specialist neonatal services assess and monitor the staffing levels, composition and competency of their workforce. In addition, they ensure that appropriate education programmes are commissioned.
Parents of babies receiving specialist neonatal care can expect care to be given by an appropriate number of fully trained healthcare professionals.

Definitions

Definition of a skilled and competent workforce can be found in Department of Health toolkit (2009) Principle 2.
The process measure 'proportion of completed shifts with the correct nursing and medical staffing levels' was considered by the Topic Expert Group (TEG) as an appropriate measure of staffing. It is noted that this is not a mandatory data collection requirement and that collection of this data is at the discretion of local units.

Data source

Structure
Local data collection.
Process
Local data collection.

Neonatal transfer services

This quality statement is taken from the neonatal specialist care quality standard. The quality standard defines clinical best practice in neonatal specialist care and should be read in full.

Quality statement

Neonatal transfer services provide babies with safe and efficient transfers to and from specialist neonatal care.

Quality measure

Structure
Evidence of network arrangements to provide a 24-hour, 7 days a week neonatal transport service with a single telephone contact.
Process
(a) Proportion of transfer teams responding to time-critical emergencies that depart from the transport base within 1 hour from the start of the referring call.
Numerator: the number of transfer teams departing from the transport base within 1 hour from the start of the referring call.
Denominator: the number of emergency transfer requests deemed time-critical.
(b) Proportion of newborn babies who receive specialist neonatal care who have an admission temperature of less than 36°C.
Numerator: the number of newborn babies with an admission temperature of less than 36°C.
Denominator: the number of newborn babies receiving specialist neonatal care.

What the quality statement means for each audience

Service providers ensure a safe and efficient service for babies transferred to and from specialist neonatal care.
Healthcare professionals ensure babies receive a safe and efficient transfer to and from specialist neonatal care.
Commissioners and networks ensure transfer services are contracted and monitored to provide appropriate levels of service provision.
Parents of babies who need to be transferred to or from specialist neonatal services can expect this to be done safely and efficiently.

Definitions

The Department of Health toolkit (2009) states 'a transfer service is concerned with organising and implementing the transfer of babies and/or mothers from within a defined geographical area (network). It encompasses both users and providers, and transfers may be ex-utero or in-utero.'
Further description of a high quality transfer service can be found in Principle 4 of the Department of Health toolkit (2009).

Data source

Structure
Network data collection.
Process
(a) and (b): Network data collection.

Encouraging parental involvement in care

This quality statement is taken from the neonatal specialist care quality standard. The quality standard defines clinical best practice in neonatal specialist care and should be read in full.

Quality statement

Parents of babies receiving specialist neonatal care are encouraged and supported to be involved in planning and providing care for their baby, and regular communication with clinical staff occurs throughout the care pathway.

Quality measure

Structure
(a) Evidence of local arrangements to involve parents in decision-making processes.
(b) Evidence of local audit demonstrating active involvement of parents in providing care for their baby.
(c) Evidence of regular surveys on parent experience.
(d) Evidence of local arrangements to provide bereavement services.
(e) Evidence of local arrangements to provide palliative care.
Process
Parents' experience is monitored through satisfaction surveys and the evidence used to inform learning and change for improvement.

What the quality statement means for each audience

Service providers ensure a policy is in place to maintain accurate records of communication with parents of babies receiving specialist neonatal care and that parents are involved in planning and providing care. Ensure plans are in place to seek regular parental views and experience.
Healthcare professionals communicate regularly with parents of babies receiving specialist neonatal care and ensure parents are involved in decision-making and their baby's care.
Commissioners ensure services use parental feedback on involvement in decision-making and planning and provision of care to inform service improvement of specialist neonatal care.
Parents of babies receiving specialist neonatal care can expect to be encouraged and supported to be actively involved in planning and providing care, joint decision-making and to be in regular contact with their healthcare team.

Definitions

Support provided will depend on the parents’ needs and may include physical, psychological or social support.

Data source

Structure
a) and b) Local data collection. Contained within the Picker Institute Europe's neonatal survey.
c) Royal College of Paediatrics and Child Health National Neonatal Audit Programme denominator survey Question 8: In the last 12 months has the unit carried out a parent satisfaction survey?
d) and e) Local data collection.
Process
A Picker Institute parent survey, developed in conjunction with Bliss, is in development and will contain questions specifically aimed at assessing parent involvement in care and decision-making.

Breastfeeding

This quality statement is taken from the neonatal specialist care quality standard. The quality standard defines clinical best practice in neonatal specialist care and should be read in full.

Quality statement

Mothers of babies receiving specialist neonatal care are supported to start and continue breastfeeding, including being supported to express milk.

Quality measure

Structure
Evidence of a written local policy on breastfeeding and expressing milk for babies receiving specialist neonatal care.
Outcomes
(a) Proportion of babies born at less than 33 weeks of gestation who receive specialist neonatal care who are breastfed when discharged from hospital.
Numerator: the number of babies breastfed when discharged from hospital.
Denominator: the number of babies born at less than 33 weeks of gestation receiving specialist neonatal care and discharged from hospital.
(b) Proportion of babies born at less than 33 weeks of gestation who remain in hospital and still receive their mother's breast milk at 6 weeks.
Numerator: the number of babies receiving their mother's breast milk at 6 weeks.
Denominator: the number of babies born at less than 33 weeks of gestation, receiving specialist neonatal care and remaining in hospital at 6 weeks.

What the quality statement means for each audience

Service providers ensure implementation of a local policy on breastfeeding and expressing milk for babies in specialist neonatal care.
Healthcare professionals ensure all mothers of babies receiving specialist neonatal care are supported to start and continue breastfeeding, including support to express milk.
Commissioners ensure services audit their compliance against agreed standards on supporting mothers to start and continue breastfeeding, including support to express milk.
Mothers of babies receiving specialist neonatal care can expect to be offered support to start and continue to breastfeed, including support to express milk.

Data source

Structure
Local data collection. Contained within the Picker Institute Europe's neonatal survey.
Outcome
a) Royal College of Paediatrics and Child Health National Neonatal Audit Programme produces figures on feeding status at discharge for babies born at less than 33 weeks of gestation. Also contained within the Picker Institute Europe's neonatal survey.
b) Local data collection.

Coordinated transition to community care

This quality statement is taken from the neonatal specialist care quality standard. The quality standard defines clinical best practice in neonatal specialist care and should be read in full.

Quality statement

Babies receiving specialist neonatal care have their health and social care plans coordinated to help ensure a safe and effective transition from hospital to community care.

Quality measure

Structure
(a) Evidence of provision of a neonatal outreach service.
(b) Evidence of multiagency discharge planning with input from community neonatal outreach services.
Process
Proportion of babies discharged from specialist neonatal care who receive an outreach service follow-up.
Numerator: the number of babies receiving outreach service follow-up.
Denominator: the number of babies discharged from specialist neonatal care requiring an outreach service follow-up.

What the quality statement means for each audience

Service providers ensure that agreements are in place for coordinating the care plans of babies receiving specialist neonatal care between relevant agencies.
Health and social care professionals ensure the care plans of babies receiving specialist neonatal care are coordinated with all relevant agencies.
Commissioners and networks ensure services are commissioned according to agreed levels of care across the specialist neonatal care pathway to enable safe and effective transition from hospital to community care.
Parents of babies discharged from specialist neonatal care can expect to receive support from health or social care professionals working in the community if their baby requires it. They can also expect that their baby's care plan will be coordinated between relevant teams to help ensure a safe and effective transition from hospital to home.

Data source

Structure
(a) and (b): Local and network data collection.
Process
Local and network data collection.

Data, audit and research

This quality statement is taken from the neonatal specialist care quality standard. The quality standard defines clinical best practice in neonatal specialist care and should be read in full.

Quality statement

Providers of specialist neonatal services maintain accurate and complete data, and actively participate in national clinical audits and applicable research programmes.

Quality measure

Structure
(a) Evidence of a documented data validation process to ensure data completeness and accuracy.
(b) Evidence of participation in national clinical audits and benchmarking.
(c) Evidence of participation in applicable research studies.
Process
(a) Complete and accurate data collected for the National Neonatal Audit Programme.
(b) Complete and accurate data collected for the BAPM dataset.
(c) Proportion of babies receiving specialist neonatal care whose parents are invited to participate in applicable research studies.
Numerator: the number of babies whose parents are invited to participate in applicable research studies.
Denominator: the number of babies receiving specialist neonatal care.

What the quality statement means for each audience

Service providers ensure accuracy and completeness of specialist neonatal data collection systems and participate in national clinical audits and applicable research programmes.
Healthcare professionals ensure accurate record keeping and data collection.
Commissioners ensure service providers participate in agreed national clinical audits and applicable research programmes.
Parents of babies receiving specialist neonatal care can expect complete and accurate information to be kept about their baby's care and for it to be used to improve care. They can also expect to be invited to participate in applicable research programmes.

Data source

Structure
a) Local and network data collection.
b) Participation in Royal College of Paediatrics and Child Health National Neonatal Audit Programme.
Process
a) Royal College of Paediatrics and Child Health National Neonatal Audit Programme provides quarterly data completeness and accuracy reports to participating sites.
b) Data completeness and accuracy figures of BAPM dataset submissions.

Health outcomes

This quality statement is taken from the neonatal specialist care quality standard. The quality standard defines clinical best practice in neonatal specialist care and should be read in full.

Quality statement

Babies receiving specialist neonatal care have their health outcomes monitored.

Quality measure

Structure
Evidence of processes to enable collection of health outcome data within the network for babies who receive specialist neonatal care.
Process
(a) Proportion of babies born at less than 30 weeks of gestation who received specialist neonatal care who have a 2-year outcome form completed.
Numerator: the number of babies with a completed 2-year outcome form.
Denominator: the number of babies born at less than 30 weeks of gestation receiving specialist neonatal care.
(b) Proportion of babies born at 30 weeks of gestation or more who received specialist neonatal care who have a 2-year outcome form completed.
Numerator: the number of babies with a completed 2-year outcome form.
Denominator: the number of babies born at 30 weeks of gestation or more receiving specialist neonatal care.
(c) Proportion of babies born at less than 32 weeks of gestation and/or with a birth weight less than 1501 g who receive specialist neonatal care and undergo retinopathy screening prior to discharge from hospital.
Numerator: the number of babies undergoing retinopathy screening prior to discharge from hospital.
Denominator: the number of babies born at less than 32 weeks of gestation and/or with a birth weight less than 1501 g, receiving specialist neonatal care and discharged from hospital.
(d) Proportion of babies born at less than 32 weeks of gestation and/or with a birth weight less than 1501 g who receive specialist neonatal care who require laser surgery.
Numerator: the number of babies requiring laser surgery.
Denominator: the number of babies born at less than 32 weeks of gestation and/or with a birth weight less than 1501 g receiving specialist neonatal care.
e) Proportion of babies who received specialist neonatal care who have had a culture-positive infection of blood or cerebrospinal fluid prior to discharge from hospital.
Numerator: the number of babies who have had a culture-positive infection of blood or cerebrospinal fluid prior to discharge from hospital.
Denominator: the number of babies receiving specialist neonatal care.
f) Proportion of babies who have had neonatal encephalopathy.
Numerator and denominator under development for the National Neonatal Audit Programme.
Outcomes
(a) Proportion of babies born at less than 30 weeks of gestation who receive specialist neonatal care who have no functional impairment at 2 years when corrected for gestational age.
Numerator: the number of babies with no functional impairment at 2 years when corrected for gestational age.
Denominator: the number of babies born at less than 30 weeks of gestation receiving specialist neonatal care.
(b) Proportion of babies born at 30 weeks of gestation or more who receive specialist neonatal care who have no functional impairment at 2 years when corrected for gestational age.
Numerator: the number of babies with no functional impairment at 2 years when corrected for gestational age.
Denominator: the number of babies born at 30 weeks of gestation or more receiving specialist neonatal care.
(c) 2-year survival rates within and compared with other networks.

What the quality statement means for each audience

Service providers ensure the health outcomes of all babies receiving specialist neonatal care are monitored.
Healthcare professionals ensure accurate and complete baseline data collection through pregnancy, childbirth and the perinatal period.
Commissioners and networks ensure specialist neonatal care health outcomes are monitored and used to inform service improvement.
Parents of babies receiving specialist neonatal care can expect their baby's health will continue to be assessed after discharge from hospital.

Data source

Structure
Royal College of Paediatrics and Child Health National Neonatal Audit Programme collects data on whether health outcomes are collected.
Process
a) and b) Royal College of Paediatrics and Child Health National Neonatal Audit Programme collects data on whether 2-year outcomes are collected.
c) Royal College of Paediatrics and Child Health National Neonatal Audit Programme collects data on retinopathy screening prior to discharge from hospital for babies born at less than 32 weeks or gestation and/or with a birth weight less than 1501 g.
d) Local and network data collection.
e) Royal College of Paediatrics and Child Health National Neonatal Audit Programme will collect data on babies who have had a culture-positive infection of blood or cerebrospinal fluid prior to discharge.
f) Royal College of Paediatrics and Child Health National Neonatal Audit Programme will collect data on neonatal encephalopathy.
Outcomes
a) and c) Network data collection.
b) Network data collection. Also contained within the Royal College of Paediatrics and Child Health National Neonatal Audit Programme.

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Implementation

NICE has produced resources to help implement its guidance on:

Information for the public

NICE has written information for the public on each of the following topics.

Pathway information

Patient-centred care

Parents and carers have the right to be involved in planning and making decisions about their baby's health and care, and to be given information and support to enable them to do this, as set out in the NHS constitution and summarised in making decisions about your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Supporting information

Benefits and harms of dexamethasone in preterm babies 8 days or older
Outcome
Benefit or harm for preterm babies 8 days or older
Notes
Mortality before discharge
There is no difference in mortality before discharge in babies who receive dexamethasone compared with babies who do not receive dexamethasone.
There was evidence demonstrating this lack of difference.
BPD at 36 weeks' postmenstrual age
Babies who receive dexamethasone are less likely to develop BPD compared with babies who do not receive dexamethasone.
On average:
  • without dexamethasone treatment, 63 babies per 100 would develop BPD (and 37 would not)
  • with dexamethasone treatment, 47 babies per 100 would develop BPD (and 53 would not).
There was evidence demonstrating this difference.
Cerebral palsy
There is no difference in the incidence of cerebral palsy in babies who receive dexamethasone compared with babies who do not receive dexamethasone.
Although there was evidence demonstrating this lack of difference, there is uncertainty about the risk, so the possibility of cerebral palsy occurring could not be excluded.
Other neurodevelopmental outcomes (neurodevelopmental delay and neurosensory impairment)1
There is no difference in neurodevelopmental outcomes in babies who receive dexamethasone compared with babies who do not receive dexamethasone.
Although there was evidence demonstrating this lack of difference, there is uncertainty about the risk of neurodevelopmental delay and neurosensory impairment because the studies reported neurodevelopmental assessments at different timepoints.
Days on invasive ventilation
Babies who receive dexamethasone have fewer days on invasive ventilation compared with babies who do not receive dexamethasone.
Although there was evidence demonstrating this difference, there is uncertainty about the difference in the number of days on invasive ventilation because of the different ways the studies reported it.
Gastrointestinal perforation
There is no difference in gastrointestinal perforation in babies who receive dexamethasone compared with babies who do not receive dexamethasone.
Although there was evidence demonstrating this lack of difference, there is uncertainty about the risk, so the possibility of gastrointestinal perforation occurring cannot be excluded.
Hypertension
Babies who receive dexamethasone are more likely to develop hypertension compared with babies who do not receive dexamethasone.
On average:
  • without dexamethasone treatment, 3 preterm babies per 100 would develop hypertension (and 97 would not)
  • with dexamethasone treatment, 11 babies per 100 would develop hypertension (and 89 would not).
There was evidence demonstrating this difference.
Full details of the evidence for the benefits and harms of dexamethasone for preterm babies 8 days or older are in evidence review C: managing respiratory disorders.
1 In this NICE Pathway, neurodevelopmental outcomes at 18 months or older have been defined as:
  • cerebral palsy (reported as presence or absence of condition, not severity)
  • neurodevelopmental delay (reported as dichotomous outcomes, not continuous outcomes such as mean change in score)
    • severe (score of more than 2 SD below normal on validated assessment scales, or a score of less than 70 on the Bayley II scale of infant development MDI or PDI, or complete inability to assign score because of cerebral palsy or severe cognitive delay)
    • moderate (score of 1 to 2 SD below normal on validated assessment scales, or a score of 70 to 84 on the Bayley II scale of infant development MDI or PDI)
  • neurosensory impairment (reported as presence or absence of condition, not severity):
    • severe hearing impairment (for example, deaf)
    • severe visual impairment (for example, blind).

Invasive ventilation

Administration of respiratory support via an endotracheal tube or tracheostomy, using a mechanical ventilator – see the table for a summary of the definitions of invasive ventilation modes.
Identified risk factors for bronchopulmonary dysplasiaa
In babies born before 32 weeks
  • lower gestational age
  • Lower birthweight
  • Small for gestational age
  • Male sex
  • Core body temperature of less than 35°C on admission to neonatal unit
  • Invasive ventilation begun within 24 hours of birth
  • Clinical sepsis with or without positive blood cultures
  • Feeding with formula milk (exclusively or in addition to breast milk)
  • Treated with surfactantb
  • Treated for a PDAb
In babies born before 30 weeks
  • Cardiopulmonary resuscitation performed at birth
a These risk factors have been identified in large prospective cohort studies, but other gestational ages and other risk factors not listed here might also be associated with an increased risk of bronchopulmonary dysplasia.
b These risk factors are likely to reflect the severity of the baby's condition. Surfactant should be used, and a PDA should be treated, where clinically appropriate.

Glossary

assist control
bronchopulmonary dysplasia
continuous positive airways pressure
high-frequency oscillatory ventilation
mental developmental index
non-steroidal anti-inflammatory drugs
carbon dioxide partial pressure
psychomotor developmental index
patent ductus arteriosus
pressure support ventilation
patient-triggered ventilation
respiratory distress syndrome
synchronised intermittent mandatory ventilation
synchronised intermittent positive pressure ventilation
synchronised time-cycled pressure-limited ventilation
volume-targeted ventilation
(administration of surfactant through a thin endotracheal catheter without insertion of an endotracheal tube or invasive ventilation)
(the tidal volume of each breath in millilitres [ml] multiplied by the number of breaths per minute gives the minute ventilation in ml/min (usually expressed as ml/kg/min, which is achieved by dividing by the baby's weight in kg))
(sounds, characteristics of movements including facial expressions and physiological parameters such as heart rate, breathing patterns and skin tone that reflect the baby's current level of sensitivity or wellbeing, and reveal their current developmental stage)
(administration of respiratory support using a ventilator or flow driver, but not via an endotracheal tube or tracheostomy)
(in this guidance, the perinatal period is defined as the period of time from 48 hours before birth up until 7 completed days after birth)
standard deviation
(holding a naked baby, or a baby wearing only a nappy, on the skin of a parent or carer, usually on the chest)
(facilitating and supporting a smooth transition from fetal to neonatal life; involves careful assessment of heart rate, colour [oxygenation] and breathing, with provision of appropriate interventions where indicated)

Paths in this pathway

Pathway created: April 2019 Last updated: April 2019

© NICE 2019. All rights reserved. Subject to Notice of rights.

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