Abstract
Respiratory Distress Syndrome (RDS) is the commonest diagnosis after premature birth. We aimed to audit clinical practices before and after introduction of a national guideline in Wales on RDS management. Anonymised, prospective data on all infants born at <34 weeks of gestation and cared for at one of the participating neonatal units in Wales were collected in two six-month time periods in 2015 and 2018. A national guideline was introduced in 2016 by the Wales Neonatal Network. Data collection included areas of antenatal management, delivery room stabilisation, invasive and non-invasive respiratory support, surfactant treatment and elements of supportive care. Univariate and multivariate methods were used to compare data between the two epochs. Comparing care before and after introduction of the national guideline, areas of significant improvement include use of targeted tidal volume ventilation, use of caffeine therapy, oxygen therapy post-surfactant and increasing early use of parenteral nutrition. Areas of poorer management included levels of positive end expiratory pressures and timing of introduction of enteral feeds. Little variation was seen between level two and three units, although gestational age was a significant independent variable for several practices, including delayed cord clamping, stabilisation with intubation, early enteral feeding and caffeine administration. A national guideline for management of RDS in Wales has significantly improved practice in several areas. However, despite a large volume of high-quality evidence and robust guidance, there remains a significant variation in some elements of best practice for RDS management. Further work should focus on education and training, especially for elements requiring cross-departmental work.
Highlights
Respiratory pathology is one of the commonest consequences of preterm birth[1] manifesting early as respiratory distress syndrome (RDS), a product of structurally immature lungs and pulmonary surfactant deficiency
Prospective, anonymised audits of the management of Respiratory Distress Syndrome (RDS) in all preterm infants born at
Management of RDS can have a significant impact on later morbidity, especially on the development of CLD13
Summary
Respiratory pathology is one of the commonest consequences of preterm birth[1] manifesting early as respiratory distress syndrome (RDS), a product of structurally immature lungs and pulmonary surfactant deficiency. These preterm infants often require invasive and non-invasive respiratory support, supplementary oxygen and surfactant replacement therapy. A wealth of research on the management of RDS has been published[8], which was summarised by the European consensus group as best-practice guidelines[9] This covered a broad range of care strategies related to the optimal management of RDS, including antenatal practices, early delivery room management, mechanical and non-invasive respiratory support, surfactant therapy and supportive care. This study aimed to conduct audits on the clinical practice before and after introduction of a Welsh national guideline, describe changes in management over the past three years and highlight future directions for improving care, with broad implications for early care for preterm infants in most neonatal networks in the UK
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