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[null,"Baseline assessment tool for specialist neonatal respiratory care for babies born preterm (NICE guideline NG124)"]
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[null,"This baseline assessment tool can be used to evaluate whether practice is in line with the recommendations in specialist neonatal respiratory care for babies born preterm.  It can also help to plan activity to meet the recommendations."]
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[null,"The tool can be used by individual services or organisations. Alternatively, an assessment completed with the involvement of all relevant services or organisations would help to develop a picture of activity in the local area."]
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[null,"It should be used in conjunction with specialist neonatal respiratory care for babies born preterm (NICE guideline NG124)."]
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[null,"In the first instance, consider whether the guideline is relevant and record the conclusion in the box below."]
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[null,"Is the guideline relevant?"]
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[null,"The data sheet contains the recommendations from the guideline. Information can be entered about current activity relevant to the recommendation, actions needed to meet the recommendation, deadlines and the names of the responsible leads.  Useful documents can be added as hyperlinks."]
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[null,"The table can be adapted to include any other local information that is thought to be useful."]
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[null,"If it would be helpful to group the recommendations, for example those that are key priorities for implementation or by deadline, use the filter function in the data menu. "]
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[null,"Tools and resources to help put the guidance into practice are available on the NICE website. "]
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[null,"National Institute for Health and Care Excellence\nLevel 1A, City Tower, Piccadilly Plaza, Manchester M1 4BT; www.nice.org.uk\n\nCopyright\n© NICE 2021. All rights reserved. Subject to Notice of rights.\n"]

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[null,"Baseline assessment tool for specialist neonatal respiratory care for babies born preterm (NICE guideline NG124)"]
[]
[null,null,null,null,"Number of relevant recommendations",{"$f":"COUNTIF(D8:D999,\"Yes\")","v":0}]
[null,null,null,null,"Number of recommendations met",{"$f":"COUNTIF(F8:F999,\"Yes\")","v":0}]
[null,null,null,null,"Percentage of recommendations met",{"$f":"IF(ISERROR(F4/F3),\"\",F4/F3)","v":""}]
[]
[null,"NICE recommendation","Guideline reference","Is the recommendation relevant?","Current activity/evidence","Recommendation met?","Actions needed to implement recommendation","Is there a risk associated with not implementing this recommendation?","Is there a cost or saving?","Deadline","Lead"]
[null,"1.1 Risk factors for bronchopulmonary dysplasia"]
[null,"Be aware that the risk factors for bronchopulmonary dysplasia (BPD) include those in table 1. Note that the risk factors 'treated with surfactant' and 'treated for a patent ductus arteriosus (PDA)' are likely to reflect the severity of the baby’s condition. Surfactant should be used, and a PDA should be treated, where clinically appropriate.","1.1.1"]
[null,"1.2 Respiratory support for preterm babies"]
[null,"Respiratory support before admission to the neonatal unit"]
[null,"When stabilising preterm babies who need respiratory support soon after birth and before admission to the neonatal unit, use continuous positive airways pressure (CPAP) where clinically appropriate, rather than invasive ventilation.","1.2.1"]
[null,"Surfactant"]
[null,"Give surfactant to preterm babies who need invasive ventilation for stabilisation in the early postnatal period.","1.2.2"]
[null,"When giving surfactant to a preterm baby who does not need invasive ventilation, use a minimally invasive administration technique. If this is not possible, for example, in units without the facilities or trained staff to carry out these techniques, use endotracheal intubation to give surfactant, with early extubation afterwards.","1.2.3"]
[null,"Oxygen"]
[null,"Use nasal cannula or incubator oxygen for preterm babies who need supplemental oxygen.","1.2.4"]
[null,"Humidify oxygen when giving oxygen at higher flow rates, such as 2 litres per minute or more.","1.2.5"]
[null,"Non-invasive ventilation techniques in the neonatal unit"]
[null,"For preterm babies who need non-invasive ventilation, consider nasal CPAP or nasal high-flow therapy as the primary mode of respiratory support.","1.2.6"]
[null,"Invasive ventilation techniques in the neonatal unit"]
[null,"For preterm babies who need invasive ventilation, use volume-targeted ventilation (VTV) in combination with synchronised ventilation as the primary mode of respiratory support. If this is not effective, consider high-frequency oscillatory ventilation (HFOV).","1.2.7"]
[null,"For preterm babies who need invasive ventilation but VTV and HFOV are not available or not suitable, consider synchronised intermittent mandatory ventilation (SIMV).","1.2.8"]
[null,"Do not use synchronised pressure-limited ventilation such as assist control (AC), synchronised intermittent positive pressure ventilation (SIPPV), patient-triggered ventilation (PTV), pressure support ventilation (PSV) or synchronised time-cycled pressure-limited ventilation (STCPLV).","1.2.9"]
[null,"Nitric oxide"]
[null,"Do not routinely use inhaled nitric oxide for preterm babies who need respiratory support for respiratory distress syndrome (RDS), unless there are other indications such as pulmonary hypoplasia or pulmonary hypertension.","1.2.10"]
[null,"1.3 Managing respiratory disorders"]
[null,"Corticosteroids"]
[null,"Consider dexamethasone to reduce the risk of BPD for preterm babies who are 8 days or older and still need invasive ventilation for respiratory disease. When considering whether to use dexamethasone in these babies:\n• take into account the risk factors for BPD in table 1 and\n• discuss the possible benefits and harms with the parents or carers. Topics to discuss include those in table 2. ","1.3.1"]
[null,"For preterm babies who are younger than 8 days old, be aware that dexamethasone increases the risk of gastrointestinal perforation.","1.3.2"]
[null,"Do not use dexamethasone with non-steroidal anti-inflammatory drugs (NSAIDs).","1.3.3"]
[null,"Monitor the blood pressure of babies who receive dexamethasone, because of the risk of hypertension.","1.3.4"]
[null,"Caffeine citrate"]
[null,"Use caffeine citrate routinely in preterm babies born at or before 30 weeks, starting it as early as possible and ideally before 3 days of age.","1.3.5"]
[null,"Consider stopping caffeine citrate at 33 to 35 weeks’ corrected gestational age if the baby is clinically stable.","1.3.6"]
[null,"Consider caffeine citrate for any preterm baby with apnoea.","1.3.7"]
[null,"Give a loading dose of 20 mg/kg of caffeine citrate, followed 24 hours later by a maintenance dosage of 5 mg/kg once daily, increasing up to 20 mg/kg daily if episodes of apnoea persist.","1.3.8"]
[null,"Consider a maintenance dosage higher than 20 mg/kg daily5 if therapeutic efficacy is not achieved, while ensuring that a safe plasma level is maintained.","1.3.9"]
[null,"Patent ductus arteriosus"]
[null,"Do not treat a patent ductus arteriosus (PDA) in a preterm baby unless the PDA causes a significant clinical problem, for example, difficulty weaning the baby from a ventilator.","1.3.10"]
[null,"1.4 Monitoring"]
[null,"Oxygen"]
[null,"Use continuous pulse oximetry to measure oxygen saturation in preterm babies, supplemented by arterial sampling if clinically indicated.","1.4.1"]
[null,"After initial stabilisation, aim for an oxygen saturation of 91 to 95% in preterm babies.","1.4.2"]
[null,"For preterm babies on invasive ventilation who are clinically unstable, consider transcutaneous oxygen monitoring.","1.4.3"]
[null,"Carbon dioxide"]
[null,"For preterm babies on invasive ventilation, aim for a carbon dioxide partial pressure (PCO2) of:\n• 4.5 to 8.5 kPa on days 1 to 3 and \n• 4.5 to 10 kPa from day 4 onwards.","1.4.4"]
[null,"Reduce minute ventilation without delay in preterm babies with a low PCO2, and check the PCO2 within an hour of the low measurement being identified.","1.4.5"]
[null,"Blood pressure"]
[null,"Do not treat preterm babies for hypotension based solely on specific blood pressure thresholds, but take into account other factors, such as evidence of poor tissue perfusion. The aim of treatment should be to improve perfusion.","1.4.6"]
[null,"1.5 Sedation and analgesia"]
[null,"Morphine"]
[null,"Do not routinely use morphine for preterm babies on respiratory support.","1.5.1"]
[null,"Consider morphine if the baby is in pain. Assess the baby's pain using locally agreed protocols or guidelines.","1.5.2"]
[null,"Regularly reassess babies on morphine to ensure that it is stopped as soon as possible. ","1.5.3"]
[null,"Premedication before intubation"]
[null,"Consider premedication before elective non-urgent intubation in preterm babies.","1.5.4"]
[null,"If giving premedication, consider either: \n• an opioid analgesic (for example, morphine or fentanyl), combined with a neuromuscular blocking agent (for example, suxamethonium) or\n• propofol  alone.","1.5.5"]
[null,"1.6 Involving, supporting and informing parents and carers"]
[null,"NICE has produced a guideline on babies, children and young people's experience of healthcare."]
[null,"Involving parents and carers while their preterm baby is on respiratory support"]
[null,"Explain to the parents and carers of preterm babies on respiratory support that non-nutritive sucking (using a dummy) during periods when the baby is awake is beneficial because:\n• it can help soothe the baby between feeds and\n• in babies fed by a nasogastric tube, dummy use can reduce the length of the baby’s hospital stay. ","1.6.1"]
[null,"Tell parents and carers about the benefits of using touch, for example through skin-to-skin contact, to communicate with their baby.","1.6.2"]
[null,"Consider providing the Newborn individualized developmental care and assessment program (NIDCAP®) to improve cognitive development in babies born at less than 27 weeks.","1.6.3"]
[null,"Supporting parents and carers while their preterm baby is on respiratory support"]
[null,"Recognise parents and carers as partners in their baby’s care, and support them in this role.","1.6.4"]
[null,"Encourage and support parents and carers to: \n• be involved in planning and providing their baby’s day-to-day care, for example, feeding and nappy changing\n• participate in discussions and decisions about their baby during ward rounds, providing input into planning and providing care.","1.6.5"]
[null,"Provide regular opportunities and time for parents and carers to discuss their baby’s care, ask questions about the information they have been given, and discuss concerns.","1.6.6"]
[null,"Give parents and carers the time, support and encouragement they need to become confident in caring effectively for their baby.","1.6.7"]
[null,"Offer parents and carers psychological support from a professional who is trained to deliver this type of help and advice.","1.6.8"]
[null,"Providing information to parents and carers while their preterm baby is on respiratory support"]
[null,"Ask parents and carers about how and when they would like to receive information about their baby's treatment and progress, and how they would prefer to be contacted when they are away from the neonatal unit.","1.6.9"]
[null,"Support discussions with parents and carers using written information. Ensure that information is up to date, relevant, appropriate to the parents' and carers' needs and preferences, and consistent between healthcare professionals. For more guidance on communication (including different formats and languages), providing information, and shared decision making, see the NICE guidelines on patient experience in adult NHS services and shared decision making.","1.6.10"]
[null,"Ensure that information for parents and carers is delivered by an appropriate healthcare professional, and information for hospitalised mothers who cannot visit their baby is delivered by a senior healthcare professional, for example, a neonatologist or specialist registrar, face-to-face whenever possible.","1.6.11"]
[null,"Be sensitive about the timing of discussions with parents and carers. In particular, discuss significant perinatal events without delay, providing the mother has sufficiently recovered from the birth.","1.6.12"]
[null,"Provide information for parents and carers that includes:\n• explanations and regular updates about their baby's condition and treatment, especially if there are any changes\n• what happens in the neonatal unit, and the equipment being used to support their baby\n• what respiratory support is being provided for their baby \n• how to get involved in their baby’s day-to-day care, interact with their baby and interpret the baby’s neurobehavioural cues\n• the roles and responsibilities of different members of their baby’s healthcare team, and key contacts\n• information about caring for a premature baby to share with family and friends, and practical suggestions about how to get help and support from family and friends\n• opportunities for peer support from neonatal unit graduate parents or parent buddies\n• details of local support groups, online forums and national charities, and how to get in touch with them.","1.6.13"]
[null,"Neonatal services for preterm babies on respiratory support"]
[null,"Those responsible for planning and delivering neonatal services should ensure that neonatal units:\n• are welcoming and friendly\n• foster positive and supportive relationships by providing parents and carers with 24-hour access to their baby\n• provide privacy for skin-to-skin contact and feeding\n• have private areas for difficult conversations\n• have comfortable furniture and provide a relaxing environment for families.","1.6.14"]
[null,"Ensure that healthcare professionals in neonatal units can support parents and carers by being competent in:\n• communicating complex and sensitive information clearly\n• tailoring information and support to the person’s individual needs and circumstances.","1.6.15"]
[null,"1.7 Discharge planning"]
[null,"Planning safe discharge from the neonatal unit for preterm babies on respiratory support"]
[null,"Neonatal units should consider appointing a member of staff as a designated neonatal discharge coordinator to discuss the following with parents and carers:\n• ongoing support and follow-up after discharge (also see the NICE guideline on developmental follow-up of children and young people born preterm)\n• how to care for their baby at home\n• how to use specialist equipment safely\n• how to travel with their baby and specialist equipment.","1.7.1"]
[null,"When planning to discharge a preterm baby on respiratory support from the neonatal unit:\n• follow the principles in the NICE guideline on postnatal care \n• consider early referral to, and regular contact with, community and continuing healthcare teams \n• consider an interim discharge placement to, for example, a hospice, alternative family member’s home, step-down unit, transitional care unit, or alternative suitable accommodation, where appropriate.","1.7.2"]
[null,"Supporting and providing information to parents and carers of preterm babies on respiratory support – preparing for discharge"]
[null,"Recognise parents and carers as partners in the discharge planning process. Answer their questions and concerns as they arise, and support them in making joint decisions with the discharge team.","1.7.3"]
[null,"Throughout the baby’s neonatal admission, provide support and guidance for parents and carers with constructive and supportive feedback about how to care for their baby and how to use specialist equipment. Use a formal competency-based assessment tool to evaluate the safe use of specialist equipment.","1.7.4"]
[null,"Discuss any modifications that parents and carers might need to make to their home as soon as possible.","1.7.5"]
[null,"Educate parents and carers about possible emergencies that may arise, how to deal with them and who to contact for help and advice. This should include how to carry out cardiopulmonary resuscitation, and what to do if there are problems with any specialist equipment.","1.7.6"]
[null,"Provide parents and carers with opportunities to care for their baby overnight.","1.7.7"]
[null,"Provide information for parents and carers to help them care for their baby safely and confidently after discharge. Follow the principles on communication and information-giving in section 1.6 of this guideline, and also see the NICE guideline on postnatal care. Information should include:\n• how to recognise signs of illness in their baby, and what to do\n• how to adapt routines such as feeding and sleeping after discharge, and information about safe sleep guidance\n• how to make follow-up appointments and timing of immunisations\n• who to contact after discharge, as well as a list of useful medical contacts.","1.7.8"]
[null,"Tell parents and carers about sources of support after discharge, for example:\n• opportunities for peer support \n• help and support for their own needs, for example, postnatal depression (also see the NICE guideline on antenatal and postnatal mental health).","1.7.9"]

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["Table 1 Identified risk factors for bronchopulmonary dysplasiaa"]
["In babies born before 32 weeks","·        lower gestational age"]
[null,"·        lower birthweight"]
[null,"·        small for gestational age"]
[null,"·        male sex"]
[null,"·        core body temperature of less than 35°C on admission to neonatal unit"]
[null,"·        invasive ventilation begun within 24 hours of birth"]
[null,"·        clinical sepsis with or without positive blood cultures"]
[null,"·        feeding with formula milk (exclusively or in addition to breast milk)"]
[null,"·        treated with surfactant b"]
[null,"·        treated for a patent ductus arteriosus (PDA) b"]
["In babies born before 30 weeks","·        cardiopulmonary resuscitation performed at birth"]
["a These risk factors have been identified in large prospective cohort studies, but other gestational ages and other risk factors not listed here might also be associated with an increased risk of bronchopulmonary dysplasia."]
["b These risk factors are likely to reflect the severity of the baby’s condition. Surfactant should be used, and a PDA should be treated, where clinically appropriate. "]
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["Table 2 Benefits and harms of dexamethasone in preterm babies 8 days or older"]
["Outcome","Benefit or harm for preterm babies 8 days or older","Notes"]
["Mortality before discharge","There is no difference in mortality before discharge in babies who receive dexamethasone compared with babies who do not receive dexamethasone.","There was evidence demonstrating this lack of difference."]
["BPD at 36 weeks’ postmenstrual age","Babies who receive dexamethasone are less likely to develop BPD compared with babies who do not receive dexamethasone.","There was evidence demonstrating this difference."]
[null,"On average:"]
[null,"· without dexamethasone treatment, 63 babies per 100 would develop BPD (and 37 would not)"]
[null,"· with dexamethasone treatment, 47 babies per 100 would develop BPD (and 53 would not)."]
["Cerebral palsy","There is no difference in the incidence of cerebral palsy in babies who receive dexamethasone compared with babies who do not receive dexamethasone.","Although there was evidence demonstrating this lack of difference there is uncertainty about the risk, so the possibility of cerebral palsy occurring cannot be excluded."]
["Other neurodevelopmental outcomes (neurodevelopmental delay and neurosensory impairment)","There is no difference in neurodevelopmental outcomes in babies who receive dexamethasone compared with babies who do not receive dexamethasone.","Although there was evidence demonstrating this lack of difference, there is uncertainty about the risk of neurodevelopmental delay and neurosensory impairment because the studies reported neurodevelopmental assessments at different timepoints."]
["Days on invasive ventilation","Babies who receive dexamethasone have fewer days on invasive ventilation compared with babies who do not receive dexamethasone.","Although there was evidence demonstrating this difference, there is uncertainty about the difference in the number of days on invasive ventilation because of the different ways the studies reported it."]
["Gastrointestinal perforation","There is no difference in gastrointestinal perforation in babies who receive dexamethasone compared with babies who do not receive dexamethasone.","Although there was evidence demonstrating this lack of difference, there is uncertainty about the risk, so the possibility of gastrointestinal perforation occurring cannot be excluded."]
["Hypertension","Babies who receive dexamethasone are more likely to develop hypertension compared with babies who do not receive dexamethasone.","There was evidence demonstrating this difference."]
[null,"On average:"]
[null,"· without dexamethasone treatment, 3 preterm babies per 100 would develop hypertension (and 97 would not)"]
[null,"· with dexamethasone treatment, 11 babies per 100 would develop hypertension (and 89 would not)."]
["Full details of the evidence for the benefits and harms of dexamethasone for preterm babies 8 days or older are in evidence review C: managing respiratory disorders."]
["Abbreviation: BPD, bronchopulmonary dysplasia."]