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Specialist neonatal respiratory care for babies born preterm

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Quality statement 2: Minimally invasive administration of surfactant

Quality statement

Preterm babies who need surfactant are given it using a minimally invasive technique if they do not need invasive ventilation.

Rationale

Surfactant can be given to preterm babies using a minimally invasive technique if they are not on invasive ventilation. Using a minimally invasive technique reduces the risk of bronchopulmonary dysplasia (BPD) and pneumothorax (collapsed lung), and the number of days on invasive ventilation.

Quality measures

Structure

a) Evidence of local arrangements and written clinical protocols to ensure that preterm babies who do not need invasive ventilation receive surfactant using a minimally invasive technique.

Data source: Local data collection, for example, clinical protocols on surfactant administration and clinical governance oversight.

b) Evidence of staff training in a minimally invasive surfactant administration technique.

Data source: Local data collection, for example, the number of staff trained in a minimally invasive surfactant administration technique.

Process

Proportion of preterm babies who need surfactant and do not need invasive ventilation who are given surfactant using a minimally invasive technique.

Numerator – the number in the denominator who receive surfactant using a minimally invasive technique.

Denominator – the number of preterm babies who need surfactant and do not need invasive ventilation.

Data source: Local data collection, for example, local audit of patient records.

Outcome

a) Incidence of pneumothorax in preterm babies.

Data source: Local data collection, for example, audits of patient records.

b) Proportion of babies with BPD at 36 weeks' postmenstrual age.

Numerator – the number in the denominator with BPD.

Denominator – the number of babies at 36 weeks' postmenstrual age.

Data source: Local data collection, for example, audits of patient records. The National Neonatal Audit Programme (NNAP) measures the number of babies with BPD.

What the quality statement means for different audiences

Service providers (such as neonatal units, including special care units, local neonatal units and neonatal intensive care units) ensure that processes are in place and healthcare professionals are trained to administer surfactant using a minimally invasive technique to preterm babies who do not need invasive ventilation.

Healthcare professionals (such as specialist neonatal nurses, specialist neonatal consultants and other paediatric specialists working with babies born preterm) ensure that they do not intubate preterm babies who do not need invasive ventilation to administer surfactant. They use a minimally invasive technique to administer surfactant to these babies.

Commissioners (such as clinical commissioning groups and NHS England) ensure that they commission services that use minimally invasive techniques to administer surfactant to preterm babies who do not need invasive ventilation.

Preterm babies who need surfactant to help them breathe are given it in a way that has a low risk of problems. This is done through a thin tube into the baby's nose or mouth and passed into their airway. If the baby needs help with breathing using a ventilation machine with a tube that passes into the windpipe, surfactant is given through the tube that is already in place.

Source guidance

Specialist neonatal respiratory care in babies born preterm (2019) NICE guideline NG124, recommendation 1.2.3

Definitions of terms used in this quality statement

Minimally invasive technique

Administration of surfactant through a thin endotracheal catheter without insertion of an endotracheal tube or invasive ventilation. [NICE's guideline on specialist neonatal respiratory care in babies born preterm, terms used in this guideline section]