Clinical update

Quality standards for preterm babies who need respiratory support

NICE guidance outlines priority areas of care for premature babies requiring assisted ventilation

NICE guidance outlines priority areas of care for premature babies requiring assisted ventilation

Picture: Alamy

Essential information

About 7% of babies born in the UK each year are preterm, that is before 37 weeks gestation, according to charity Tommys .

These babies are at risk of respiratory disorders.

High-quality respiratory care for premature babies can reduce the length

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NICE guidance outlines priority areas of care for premature babies requiring assisted ventilation

Priority areas of care for premature babies requiring assisted ventilation have been issued

Picture: Alamy

Essential information

About 7% of babies born in the UK each year are preterm, that is before 37 weeks gestation, according to charity Tommy’s.

These babies are at risk of respiratory disorders.

High-quality respiratory care for premature babies can reduce the length of hospital stay and risk of long-term disability. Bronchopulmonary dysplasia (BPD), a chronic lung condition, is particularly common in preterm babies, who require assisted ventilation. The condition needs prolonged specialist care and respiratory support.

What’s new?

Latest National Institute for Health and Care Excellence (NICE) guidance sets out five standards that could improve outcomes for preterm babies who need respiratory support in hospital.

Using these standards could contribute to lower incidence of BPD, mortality and morbidity rates, and improved parent satisfaction with their baby’s care.

The quality standards set out high-quality care in priority areas for improvement and follows the publication of guidelines in 2019 on the same area of care. The five standards are:

  1. All preterm babies having respiratory support soon after birth and before admission to the neonatal unit should be given continuous positive airway pressure (CPAP), if clinically appropriate, rather than invasive ventilation. This reduces the use of unnecessary invasive ventilation and can reduce mortality before discharge and the incidence of BPD.
  2. Preterm babies who need surfactant should be given it using a minimally invasive technique if they do not need invasive ventilation, to reduce the risk of BPD and pneumothorax (collapsed lung).
  3. Those who need intensive ventilation should be given volume-targeted ventilation (VTV) in combination with synchronised ventilation, as this improves outcomes, including fewer days on ventilation.
  4. Premature babies should have a target oxygen saturation of 91% to 95% after stabilisation to reduce mortality, particularly in those born before 32 weeks.
  5. Parents should be involved in caring for their baby as much as possible.

Expert comment

Julia Petty, vice chair of the Neonatal Nurses Association

Julia Petty is vice chair of the Neonatal Nurses Association

NICE’s ventilation guidance of 2019 was well received by neonatal nurses and it was definitely needed to help standardise a complex area of care.

There has been some variation in the way ventilation care is delivered over the years, and some areas of uncertainty.

So these new quality standards, while they probably won’t hold any big surprises for neonatal nurses, confirm to everyone the consistent practice they should be implementing in these areas.

It is good to see the importance of involving parents put right at the heart of care in the quality standards, and this is something many nurses feel strongly about. It is also useful to have the oxygen saturation guidance, as this has been an area of debate in the past. This is a useful and short guide for all neonatal nurses.’

Key points for nurses

  • Involve parents and carers in planning and delivering day-to-day care for their preterm baby while in hospital, for example feeding and nappy changing, can help to support parent and carer mental health and attachment, and improve confidence.
  • If parents and carers are confident to manage their baby's condition and able to use specialist equipment safely at home, their baby may be able to come home earlier.
  • Be aware that poor mental health can affect bonding between parents and carers and their baby, so access to psychological support can be beneficial.
  • Setting a target oxygen saturation level of less than 91% increases the risk of mortality and morbidity.

Find out more

National Institute for Health and Care Excellence (2020) Specialist Neonatal Respiratory Care for Babies Born Preterm

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