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Neonatology. 2018;114(1):28-36. doi: 10.1159/000487987. Epub 2018 Apr 13.

Respiratory Management of Extremely Preterm Infants: An International Survey.

Author information

1
Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
2
Clinical Epidemiology and Biostatistics, McMaster University, Toronto, Ontario, Canada.
3
Spanish Neonatal Network, Health Research Institute La Fe, Avenida Fernando Abril Martorell, Valencia, Spain.
4
Australian and New Zealand Neonatal Network, Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, University of New South Wales, Randwick, New South Wales, Australia.
5
Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan.
6
Department of Pediatrics, Turku University Hospital, University of Turku, Turku, Finland.
7
Swedish Neonatal Quality Register, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
8
Swedish Neonatal Quality Register, Department of Pediatrics/Neonatal Services, Umeå University Hospital, Umeå, Sweden.
9
Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
10
Illinois Neonatal Network, Saint-Louis, Illinois, USA.
11
Israel Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer, Israel.
12
Australia and New Zealand Neonatal Network, Department of Paediatrics, University of Otago, Christchurch, New Zealand.
13
Neonatal Research Network Japan, Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan.
14
TIN Toscane Online, Neonatal Intensive Care Unit, Careggi University Hospital, Florence, Italy.
15
Pediatrics & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
16
UK Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, United Kingdom.

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.

KEYWORDS:

Bronchopulmonary dysplasia; Practice variation; Preterm infants; Ventilation

PMID:
29656287
DOI:
10.1159/000487987

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