University of Oxford - Medical Sciences Division - Nuffield Department of Population Health

Hannah FarleyCharles Roeh

Oxfordshire Health Research FundNational Perinatal Epidemiology Unit

No

637A-5C3F-DA28-4504-1169-DD38

Background: Babies who are born before their due date often need help to survive. This can include support with keeping warm, feeding and breathing. In the past, we have pumped air through tubes in babies' throats to help them breathe enough to stay well. We know that sometimes this can damage the lungs, which are still developing. New ways of supporting breathing in pre-term babies are an important area of research. Blowing air through a baby’s nose is a good way of helping babies born after 30 weeks of pregnancy to breathe. This also causes less problems with lung damage. We don’t know whether this is helpful for babies born earlier in pregnancy. Research aims: We want to know how hospitals helped babies born very early to breathe after they were born. This will help us learn which breathing support is best for them. We also want to know how well the breathing support worked for these babies. We can look at this by seeing if they needed oxygen when they went home. Design and methods: We have already carried out a small version of this project. We looked at the hospital records for babies in the Oxford neonatal intensive care unit (NICU). We asked what kind of breathing support babies born very early in pregnancy needed and for how long. That has helped us to work out how to look at this question across the country. We will look at hospital records for these babies across the country. These records are routinely collected for all babies to help researchers.

Recent studies have shown that non-invasive ventilation is of benefit and increasingly used in preterm infants born after 30 weeks' gestation, compared to invasive ventilation. Anecdotally, we believe that non-invasive ventilation is also being used in infants under 30 weeks' gestation, however there is no evidence base for this. Identifying current practice is the first step in assessing efficacy and building towards full evaluation of this practice through a randomised controlled trial. Extremely preterm infants who survive to child and then adulthood often have significant co-morbidities, not only in their immediate infancy but later in life. This provides a significant cost burden to health and social care services. Any change in practice that could improve outcomes in terms of lung disease and bronchopulmonary dysplasia could then lead to a reduction in morbidity, mortality and costs associated with this. As technology enables infants born at earlier gestations to be successfully resuscitated, measures to improve outcomes and reduce associated costs become more impactful. We aim to assess whether there are any centre-by-centre trends in success with resuscitation via NIV. This could help identify centres of excellence and promote protocol sharing. This work will also support the development of a randomised controlled trial thoroughly assessing the benefits of NIV in the extremely pre-term infant.

29/02/2024

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One-off

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