6048 Avoiding term admissions in neonatal units- trial of PEEP in new-borns with signs of respiratory distress at birth

Objectives Respiratory distress is the commonest cause of term admission to Neonatal Unit. However, two-thirds were only admitted for less than 48 hours.¹ The audit as outlined in the ATTAIN SOP: Avoiding Term Admissions in Neonatal Units – Respiratory Management of Term infant in the First Hour Following Birth and analyse the outcome for babies in whom 'Trial of PEEP' is attempted. In this audit trial of PEEP was performed in new-borns > 37 weeks' gestation who requiring respiratory support immediately after birth. PEEP was given at 6cm H2O for 30 minutes. [figure 1] The outcomes were then analysed to identify potential avoidance of term admission and rooms for improvement in practice. Methods Patient samples were collected between March and June 2023. Initial collection in March to May was not effectively collected with missing information, prompting a creation of specialized form and allocation to colleagues in May to June. Additional data on babies undergoing 'trial of PEEP' was identified. Excel was used for analysis, focusing on descriptive analysis. Results In this study, a total of 19 patients were included, but 4 of them were excluded because positive end-expiratory pressure (PEEP) was applied more than 1 hour after birth. Among the new-borns who received a PEEP trial at birth, 40% successfully avoided admission to the Neonatal Unit (NNU). [figure 2] Impressively, 83% of these new-borns did not require septic screens or antibiotics, underscoring the effectiveness of PEEP. Additionally, 66% of the babies admitted to NNU only needed high-flow oxygen support for less than 8 hours. Notably, three infants received PEEP for less than 30 minutes and were immediately admitted to the NNU due to ongoing respiratory distress, while three others with similar PEEP durations were observed in the postnatal ward after their respiratory effort normalized. Prolonged rupture of membrane (PROM) was identified in three patients who developed respiratory distress at 5 hours, 6 hours and 1 hour with significant meconium and failed the 'Trial of PEEP'. Conclusion The initial findings suggest that employing the 'Trail of PEEP' during delivery benefits term and late-preterm infants experiencing respiratory distress at birth. This approach appears to lower admissions to the Neonatal Nursing Unit (NNU), promoting maternal-infant bonding, reducing antibiotic usage, and potentially saving costs by averting NNU admissions. However, it's important to note that patients with Premature Rupture of Membranes (PROM) may have a distinct respiratory distress mechanism and may not respond as effectively to PEEP. Reference Reducing harm leading to avoidable admission of full-term babies into neonatal units, NHS Improvement, February 2017.