Quality standard

Quality statement 2: Minimally invasive administration of surfactant

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).

Quality measures

Structure

a) Evidence of local arrangements to ensure that preterm babies who need surfactant receive it using a minimally invasive technique if they do not need invasive ventilation.

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

a) Proportion of preterm babies born under 28 weeks of pregnancy who are given surfactant using a minimally invasive technique.

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

Denominator – the number of preterm babies born under 28 weeks of pregnancy who are given surfactant.

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

b) Proportion of preterm babies born between 28 weeks and 31 weeks plus 6 days of pregnancy who are given surfactant using a minimally invasive technique.

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

Denominator – the number of preterm babies born between 28 weeks and 31 weeks plus 6 days of pregnancy who are given surfactant.

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

c) Proportion of preterm babies born between 32 weeks and 36 weeks plus 6 days of pregnancy who are given surfactant using a minimally invasive technique.

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

Denominator – the number of preterm babies born between 32 weeks and 36 weeks plus 6 days of pregnancy who are given surfactant.

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) Number of preterm babies with BPD.

Data source: The National Neonatal Audit Programme (NNAP) measures the number of eligible babies alive at 36 weeks with sufficient data to attribute BPD outcome.

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) do not intubate preterm babies to give surfactant to babies who do not need invasive ventilation. They use a minimally invasive technique if surfactant is needed.

Commissioners (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 the least 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.

Definitions of terms used in this quality statement

Bronchopulmonary dysplasia (BPD)

A chronic lung disease that develops in preterm babies. [NICE's guideline on specialist neonatal respiratory care for babies born preterm, supplement 1: glossary and abbreviations]

Invasive ventilation

Administration of respiratory support via an endotracheal tube or tracheostomy, using a mechanical ventilator. [NICE's guideline on specialist neonatal respiratory care for babies born preterm, terms used in this guideline section]

Minimally invasive technique

Administration of surfactant through a thin endotracheal catheter without insertion of an endotracheal tube or invasive ventilation. Minimally invasive techniques are:

  • minimally invasive surfactant therapy (MIST)

  • less invasive surfactant administration (LISA)

  • avoidance of mechanical ventilation (AMV).

[NICE's guideline on specialist neonatal respiratory care for babies born preterm, terms used in this guideline section and evidence review on respiratory support]