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Neonatal respiratory care practice among level III and IV NICUs in New England

Journal of Perinatology (2024)Cite this article

Subjects

Abstract

Objectives

To assess respiratory care guidelines and explore variations in management of very low birth weight (VLBW) infants within a collaborative care framework. Additionally, to gather clinical leaders’ perspectives on guidelines and preferences for ventilation modalities.

Study design

Leaders from each NICU participated in a practice survey regarding the prevalence of unit clinical guidelines, and management, at many stages of care.

Results

Units have an average of 4.3 (±2.1) guidelines, of 9 topics queried. Guideline prevalence was not associated with practice or outcomes. An FiO2 requirement of 0.3–0.4 and a CPAP of 6–7 cmH2O, are the most common thresholds for surfactant administration, which is most often done after intubation, and followed by weaning from ventilatory support. Volume targeted ventilation is commonly used. Extubation criteria vary widely.

Conclusions

Results identify trends and areas of variation and suggest that the presence of guidelines alone is not predictive of outcome.

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Fig. 1: Availability of respiratory unit clinical guidelines for VLBW infants.
Fig. 2: Reported threshold CPAP and FiO2 levels to consider intubation of VLBW infants.
Fig. 3: Preferred ventilation strategies of VLBW infants at New England NICUs.
Fig. 4

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Data availability

The dataset generated during the current study is not publicly available as it contains identifiable information, but is available from the corresponding author on reasonable request.

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Acknowledgements

We would like to acknowledge the clinical leaders at all participating NICUs for participating in this survey.

Author information

Authors and Affiliations

  1. Beth Israel Deaconess Medical Center, Boston, MA, USA

    Helen Healy, Emily Whitesel, Justin Goldstein & Munish Gupta

  2. Boston Medical Center, Boston, MA, USA

    Bernadette Levesque & Bharati Sinha

  3. Boston Children’s Hospital, Boston, MA, USA

    Kristen T. Leeman

  4. Baystate Newborn Medicine, Springfield, MA, USA

    Ruben Vaidya

  5. UMass Memorial Medical Center, Worchester, MA, USA

    Sherman Chu

  6. Mount Auburn Hospital, Cambridge, MA, USA

    Sherman Chu

  7. Yale New Haven Health-Greenwich Hospital, Greenwich, CT, USA

    Shruti Gupta

  8. Massachusetts General Hospital, Boston, MA, USA

    Megan Aurora

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  1. Helen Healy
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Contributions

HH, MG, and MA conceptualized and designed the study, including the survey questions. HH performed initial analyses. HH, Bernadette Levesque, KTL, RV, EW, SC, JG, SG, BS, MG, and MA participated in review and interpretation of the results. HH and MA drafted the initial manuscript. All authors then critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Helen Healy.

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The authors declare no competing interests.

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Healy, H., Levesque, B., Leeman, K.T. et al. Neonatal respiratory care practice among level III and IV NICUs in New England. J Perinatol (2024). https://doi.org/10.1038/s41372-024-01926-2

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