Clinical update

Specialist neonatal respiratory care for babies born preterm

NICE has issued new guidance on respiratory care for premature babies

New NICE guidance on respiratory care for premature babies

Picture: Alamy

Essential information

Premature babies are at risk of respiratory disorders, including respiratory distress syndrome and bronchopulmonary dysplasia (BPD). High-quality respiratory care can reduce their lengths of hospital stay and risks of long-term disability.

Babies who develop BPD, which is particularly common in preterm babies who require assisted ventilation, need prolonged specialist care. Approaches to respiratory support vary between neonatal units, with many areas of uncertainty in the best way to provide this care, according to the National Institute for Health and Care Excellence (NICE).

What’s new?

NICE has published guidance to help standardise the approach to respiratory care for vulnerable preterm babies.

It calls on neonatal staff to recognise parents as partners in their children’s care and to support them in this role. Parents should be helped to provide routine baby care, such as nappy changing, and should be given the opportunities and time to ask questions about such care. They should also be encouraged to develop confidence in caring for their baby.

The guidance recommends approaches for respiratory support for preterm babies, including those who need non-invasive and invasive ventilation. It also offers advice on the use of surfactant, supplemental oxygen and nitric oxide.


The guidance calls on staff to consider premedication before elective non-urgent intubation in preterm babies, as evidence suggests this can support successful intubation while avoiding adverse affects.

NICE suggests considering the use of dexamethasone to reduce the risk of BPD for preterm babies who are eight days or older and still need invasive ventilation for respiratory disease.

It calls for units, after initial stabilisation, to aim for an oxygen saturation of 91-95% in preterm babies.

NICE also says units should consider providing the Newborn Individualized Developmental Care and Assessment Program to improve cognitive development in babies born at less than 27 weeks.

Safe discharge planning is a vital element of the document, and NICE says neonatal units should consider appointing designated neonatal discharge coordinators to provide support and explain to parents how to care for their baby at home, how to use specialist equipment safely and how to travel with their baby and specialist equipment.

Expert comment

Doris_CorkinDoris Corkin (pictured) is senior lecturer in education and Jacqueline Johnstone is a lecturer in education at the school of nursing and midwifery, Queen’s University Belfast. They are both committee members of RCN’s children and young people specialist care forum

‘Appropriate respiratory management for preterm babies is paramount because their respiratory systems are immature and breathing difficulties, such as respiratory distress syndrome, bronchopulmonary dysplasia and retinopathy of prematurity, can be common.

‘However, advances in technology have created greater choice and flexibility for preterm neonates requiring respiratory support.

‘This guidance, which is based on evidence and current clinical practice, offers advice for healthcare professionals caring for those at greatest risk. It should assist decision-making to promote quality standards of care.

‘While the National Institute for Health and Care Excellence acknowledges there is a wide variation in respiratory care throughout the UK, this user-friendly guide aims to standardise care for the vulnerable preterm neonate.  

‘One of its main recommendations for the neonatal team is to emphasise shared decision-making. This area of practice can be challenging, especially if there is disagreement between healthcare professionals and families.’

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