Abstract
Variability in neonatal clinical practice is well recognized. Respiratory management involves interdisciplinary care and often is protocol driven. The most recent published guidelines for management of respiratory distress syndrome and surfactant administration were published in 2014 and may not reflect current clinical practice in the United States. The goal of this project was to better understand variability in surfactant administration through conduct of health care provider (HCP) interviews. Questions focused on known practice variations included: use of premedication, decisions to treat, technique of surfactant administration and use of guidelines. Data were analyzed for trends and results were communicated with participants. A total of 54 HCPs participated from June to September 2020. In almost all settings, neonatologists or nurse practitioners intubated the infant and respiratory therapists administered surfactant. The INSURE (INtubation-SURrfactant-Extubation) technique was practiced by 83% of participants. Premedication prior to intubation was used by 76% of HCPs. An FiO2 ≥ 30% was the most common threshold for surfactant administration (48%). In conclusion, clinical practice variations exist in respiratory management and surfactant administration and do not seem to be specific to NICU level or institution type. It is unknown what effects the variability in clinical practice might have on clinical outcomes.
Highlights
Respiratory distress syndrome (RDS) is one of the most common diagnoses in premature infants, primarily resulting from surfactant deficiency and lung immaturity
In the most recent American Academy of Pediatrics (AAP) Clinical Report pertaining to surfactant administration, the authors conclude that due to conflicting and limited data, the optimal method of surfactant administration in preterm infants has yet to be clearly identified and there is insufficient evidence to recommend an optimal number of fractional doses of surfactant or what body position is best when surfactant is administered [2]
The results show nine different combinations were reported when participants were asked which methods of initial respiratory support management were utilized in their clinical practice
Summary
Respiratory distress syndrome (RDS) is one of the most common diagnoses in premature infants, primarily resulting from surfactant deficiency and lung immaturity. HCPs in neonatal intensive care units (NICU) often create and adhere to their own protocols based on experience, product information and their own interpretation of clinical literature. Recent studies have examined a wide variation in respiratory management in preterm infants within and across international and national networks. The impact of this variability in practice is unknown [1,5].
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