Guidance

Context

Context

In 2016, a national neonatal audit found that approximately 13% of babies in the UK need specialist neonatal care, either because they are born preterm (at less than 37 weeks) or because of an illness or condition.

A comparison of the EPICure studies published in 2012 found that, between 1995 and 2006, the number of babies born at less than 26 weeks and admitted to neonatal units increased by 30% in England. Over the same period, survival rates for babies born at 22 to 25 weeks and admitted for intensive care increased by 13%. In addition, a higher proportion of these babies survived without disability (particularly babies born at 24 to 25 weeks). International comparisons show that the neonatal mortality rate varies significantly by country.

Preterm babies are at risk of respiratory disorders, including respiratory distress syndrome and bronchopulmonary dysplasia (BPD). High-quality respiratory care can reduce the length of hospital stay and risk of long-term disability. BPD is particularly common in preterm babies who require assisted ventilation. Babies with BPD need prolonged specialist care and respiratory support.

Respiratory support is used in different ways in different units, and it is unclear what the best method is for providing ventilation and preventing BPD. There are many other areas of uncertainty and variation in how respiratory support is provided. There is also variation in other areas of respiratory management, including how corticosteroids are used to prevent and manage BPD.

Since 2013, neonatal critical care services have been managed within Operational Delivery Networks. For healthy babies and babies with minor problems, most care is provided by the hospital they are born in. Neonatal intensive care units are responsible for babies who have more complex problems. Neonatal intensive care, and the service specifications for Neonatal Critical Care and Neonatal Intensive Care Transport, are within the scope of the neonatal critical care Clinical Reference Group.

This guideline is for:

  • healthcare professionals in primary, secondary and tertiary care

  • parents and carers of babies born preterm who need respiratory support

  • commissioners and providers of specialist neonatal care services.

Groups that are covered

  • Babies born preterm who need respiratory support (for example, oxygen supplementation or assisted ventilation) in hospital, beginning in the neonatal period.

Groups that are not covered

  • Babies born at term.

  • Babies who need respiratory support because of congenital disorders, for example, congenital diaphragmatic hernia.