6841 Delivery room CPAP and less invasive surfactant administration: a successful QI project to reduce intubation rates in preterm babies

Objectives Bronchopulmonary dysplasia (BPD) is a common complication in preterm infants.¹ National data shows that our unit has higher rates of BPD compared to the national average (41.9% vs 31.2%)² as well as high intubation rates. The European consensus guideline on RDS management recommends early surfactant ideally by less invasive surfactant administration (LISA) in spontaneously breathing babies.³ Our aim was to reduce intubation rates for preterm neonates at delivery through the use of delivery room CPAP and early less invasive surfactant administration (LISA). Methods A retrospective case note review was undertaken of inborn neonates <32 weeks gestation. Data was collected in babies as part of two cohorts. Baseline data was collected for babies born in January-June 2021 (Cohort 1). Interventions included the introduction of an early respiratory care guideline based on the NICE guideline [NG124].⁴ The new guideline promotes the use of delivery room CPAP between 25–31+6 weeks gestation and early LISA. Prophylactic delivery room LISA was introduced for 25- 26+6 weeks gestation and rescue LISA was offered in NICU for more mature gestations. Post intervention data for babies born in May-October 2023 (Cohort 2) were collected. Results From Cohort 1 to Cohort 2 intubation in babies between 25 to 31+6 weeks gestation has decreased significantly from 75% to 22%. In Cohort 2, 100% of the babies born between 25 to 26+6 weeks were managed with delivery room CPAP and Delivery room LISA as per the new guideline. In Cohort 1, 9% of neonates received LISA and in Cohort 2 this increased to 34% including 5 babies who received delivery room LISA. 3 of these neonates remained on non-invasive respiratory support and avoided intubation. Overall, 85% who received surfactant by LISA (in delivery room and NICU) avoided subsequent intubation and mechanical ventilation. Conclusion Our intubation rates have decreased significantly in preterm babies through the implementation of early use of non-invasive respiratory support. There has been a noteworthy increase in less invasive surfactant administration both in delivery room and in NICU. These measures will help achieve our long term aim of reducing BPD rates in the high-risk preterm population. References Poets CF, Lorenz L. Prevention of bronchopulmonary dysplasia in extremely low gestational age neonates: current evidence. Archives of Disease in Childhood – Fetal and Neonatal Edition 2018. RCPCH. National neonatal audit programme (NNAP) 2020 annual report on 2022data. London: RCPCH 2022. https://www.rcpch.ac.uk/work-we-do/quality-improvement-patient-safety/national-neonatal-audit-programme Sweet DG, Carnielli VP, Greisen G, et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update. Neonatology 2022. NICE guideline [NG124] Specialist neonatal respiratory care for babies born preterm 03 April 2019. https://www.nice.org.uk/guidance/ng124/resources/specialist-neonatal-respiratory-care-for-babies-born-preterm-pdf-66141658884805