National surveys of UK and Italian neonatal units highlighted significant differences in the use of non-invasive respiratory support

Abstract

Aim: This study compared how non-invasive respiratory support (NRS) was provided in neonatal units in Italy and the UK.

Methods: An NRS questionnaire was sent to tertiary neonatal centres, identified by national societies, from November 2015 to May 2016.

Results: Responses were received from 49/57 (86%) UK units and 103/115 (90%) Italian units. NRS was started in the delivery room by 61% of UK units and 85% of Italian units. In neonatal intensive care units, 33% of UK units used nasal high-flow therapy (HFT) as primary support, compared to 3% in Italy. Nasal continuous positive airway pressure (CPAP) was used in 57% of UK units and 90% of Italian units. The commonest starting flow rate on nasal HFT for term and preterm infants was 6 L/min in the UK, while Italian units mainly used this flow for term infants. In the UK, 67% of units decreased nasal HFT by 1 L/min per day. In Italy, infants on nasal CPAP were weaned by 1 cm H₂ O per day in 39% of units.

Conclusion: The way that NRS was managed for very preterm infants differed between the UK and Italy, reflecting a lack of evidence on optimal NRS and the use of local protocols.

Keywords: Nasal continuous positive airway pressure; Nasal high-flow; Neonates; Prematurity; Respiratory distress syndrome.