Change in early respiratory management of infants born at less than 30 weeks' gestation in England and Wales: an observational cohort study.

OBJECTIVE: To describe changes in early respiratory support for infants born at <30 weeks' gestational age (GA) in England and Wales. DESIGN: Retrospective cohort study using data from the National Neonatal Research Database of all infants born at <30 weeks GA, admitted to neonatal units in England and Wales from 2016 to 2021. MAIN OUTCOME MEASURES: Methods of respiratory support used in the delivery room and days 1 and 7 of care were determined. Success of the initial non-invasive respiratory support strategy was assessed by any use of mechanical ventilation in the first 7 days of care. RESULTS: 24 107 babies were included. Use of continuous positive airway pressure (CPAP) and high-flow nasal cannula (HFNC) as the highest method of respiratory support for stabilisation increased during the study period (CPAP: 17.3% to 28.8%; HFNC: 0% (first recorded in 2016) to 0.7%). CPAP use increased in the most preterm (<25 weeks GA; 0.7% to 4.8%), the extremely preterm (<28 weeks GA; 7.2% to 17.5%) and the very preterm (28-29 weeks GA; 29.3% to 44.1%) cohorts. Among those initially stabilised with non-invasive ventilation in this study, 2763 (48.0%) infants required mechanical ventilation in the first week. CONCLUSIONS: In England and Wales, use of non-invasive respiratory support for initial stabilisation has increased among babies born at <30 weeks GA. 48% of those stabilised with non-invasive ventilation required mechanical ventilation in the first week. A higher quality evidence base for interventions that reduce mechanical ventilation could improve respiratory management in this population.