title: Respiratory support practices in infants born at term in the United Kingdom.
abstract: Infants born at term requiring mechanical ventilation suffer significant mortality and morbidity, yet few studies have tried to identify the optimum respiratory support for such infants. We, therefore, hypothesised that practice would vary, particularly between different levels of neonatal care provision. The lead clinicians of all 212 UK neonatal units were asked to complete an electronic web-based survey regarding respiratory support practices for term-born infants. Survey questions included the level of neonatal care provided, number of term-born infants ventilated per annum, initial and rescue ventilation modes and whether surfactant or inhaled nitric oxide (NO) were used. The overall response rate was 82 %. A greater proportion of neonatal intensive care units (NICUs) compared to local neonatal units (LNUs) stated that they used volume-targeting, particularly for infants with RDS (p = 0.0006) or congenital pneumonia (p = 0.0005). High-frequency oscillatory ventilation was stated as initial mode by a greater proportion of NICUs compared to LNUs and special care units (SCUs), particularly for respiratory distress syndrome (p < 0.0001) or persistent pulmonary hypertension of the newborn (p < 0.001). Continuous mandatory ventilation was stated to be the rescue mode by a greater proportion of LNUs/SCUs compared to NICUs (p < 0.0001). Surfactant was stated to be most commonly given for respiratory distress syndrome (79 % of units) and MAS (61 % of units); surfactant use was lowest in SCUs (p < 0.0001); inhaled NO was infrequently used by LNUs and SCUs. Conclusions There was considerable variation in respiratory support practices for term-born infants, particularly between different levels of neonatal care provision.
authors: Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, Denmark Hill, London SE5 9RS, UK.
authors: Olie
authors: O
authors: Chowdhury
authors: Catherine J
authors: CJ
authors: Wedderburn
authors: Silke
authors: S
authors: Lee
authors: Simon
authors: S
authors: Hannam
authors: Anne
authors: A
authors: Greenough
mesh_terms: D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007224:Infant Care / Q000295:instrumentation / Q000379:methods*; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008471:Meconium Aspiration Syndrome / Q000628:therapy; D009725:Nurseries, Hospital / Q000706:statistics & numerical data*; D010547:Persistent Fetal Circulation Syndrome / Q000628:therapy; D011014:Pneumonia / Q000151:congenital / Q000628:therapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D012121:Respiration, Artificial / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy; D011795:Surveys and Questionnaires; D047929:Term Birth; D006113:United Kingdom