Bolton neonatal team halves preterm baby intubation rates through new delivery room care

The neonatal team at Royal Bolton Hospital has reduced the proportion of babies born before 32 weeks requiring intubation in the delivery room from 68% to 35%, following the introduction of new respiratory care practices aimed at reducing lung damage and other complications associated with mechanical ventilation.

The quality improvement project was launched after figures from Bolton NHS Foundation Trust showed that its rates of bronchopulmonary dysplasia (BPD) in premature babies were higher than the national average.

Before the project began, 68% of babies born before 32 weeks were being intubated in the delivery room. Following implementation of the new practices, this fell to 35%.

For babies eligible for delivery room CPAP (continuous positive airway pressure), intubation rates dropped from 70% to 12%.

The project also increased the use of LISA (less invasive surfactant administration) from 9% to 35%, and 85% of babies who received LISA avoided needing breathing tubes later.

Hannah Spierson, Consultant in the Neonatal Unit, said: “While intubation can be lifesaving for premature babies who cannot breathe effectively on their own, when it can be safely avoided, intubation and mechanical ventilation can carry risks, including lung damage, long-term breathing problems and interference with early bonding.

“To support these improvements, we developed new clinical guidelines, introduced specialist equipment and delivered extensive training for our medical and nursing staff. We’re really proud that since we made these changes, nearly two thirds of babies didn’t receive intubation for breathing support during their first week of life, placing our unit above the national average.

“Families have also shared positive feedback as there is now more opportunity for parent-baby bonding at the earliest opportunity.”

The team continues to monitor outcomes and build on the improvements achieved through the initiative. Full findings and review from the quality improvement project have been published in the BMJ Journal.