736 - The 22 Week Study national survey: Variation in clinical practice for Tiny Babies across UK neonatal intensive care units

Publication Number: 2718.736

Helen McDermott, Imperial College London, Birmingham, England, United Kingdom; Cheryl Battersby, Imperial College London, London, England, United Kingdom; Jonathan Elliott, NeoTRIPs, London, England, United Kingdom

Background: In 2019, guidance from the UK British Association of Perinatal Medicine (BAPM) changed to support the provision of survival-focused care (SFC) to babies born at 22 weeks gestation in a risk-stratified approach. This resulted in a three-fold increase in SFC, with a 20% survival rate.

Objective: The 22 Week Study is a one-year project consisting of a national tertiary unit-level survey and prospective baby-level data collection in the UK. The overall aim is to describe the clinical management and short-term outcomes of babies born at 22 weeks. We report the survey results, aiming to describe clinical practices and challenges in care.

Design/Methods: The survey includes 74 questions, completed on REDCap at commencement of the 22 Week Study by the unit principal investigator and investigators, recruited via the neonatal trainee research network, NeoTRIPs. There are currently 38/50 UK neonatal intensive care units live.

Results: There were 30/38 responses.
Only 7 (23%) units have a guideline specifically for managing babies born at 22-23 weeks.
19 (63%) reported having a departmental consensus on approaching provision of SFC. All reported assessing cases individually, but with 9 discussing each on a case-by-case basis, 8 using BAPM guidance and 2 with a stronger universal SFC approach.
Variation in care practices (fig 1) and equipment availability (fig 2) are shown.
The main differences compared to international published practices include no chest xray prior to surfactant administration, the emerging use of routine echocardiography, and ubiquitous use of incubators with high humidity. Most use caffeine, probiotics, insulin and standardised starting fluid volumes, but with variation in dosing, timings and volumes. Parallel/advanced care planning is also variable.
15/28 (53%) reported equipment challenges including lack of availability of the smallest laryngoscope blades, suction and umbilical catheters and nasal prongs for non-invasive ventilation, impacting practice including prolonging invasive ventilation.

Conclusion(s): In a National Health Service, there is both consistency and variation across UK neonatal units in clinical approach and equipment availability, with little specific guidance.
This is the first report of UK unit practices in babies born at 22 weeks' gestation. Our findings support the need for development of evidence-based consensus, sharing of experiences in areas such as skin care, fluid management and procurement of infrequently-used equipment to provide intensive care to the smallest babies.
*Collaborators: https://neotrips.org/research/the-22-week-study/

Figure 1
Neonatal Unit Care Practices

Figure 2
Equipment Availability