Respiratory Practices to Prevent or Treat Evolving Bronchopulmonary Dysplasia: A European Survey

Abstract

Objective. To investigate respiratory practices to prevent or treat evolving bronchopulmonary dysplasia (BPD) in neonatal intensive care units (NICUs) across Europe. Study design. Between March and July 2024, a web-based survey was sent to European NICUs caring for infants born preterm with gestational age (GA) <28 weeks. Results. We received replies from 447/721 (62%) NICUs across 24 European countries. Almost 16% of NICUs routinely intubate at birth, especially if the GA is <24 weeks. During transition most NICUs use continuous positive airway pressure ≥5 cmH2O and start with an FiO2 0.3. Volume-targeted ventilation is the primary ventilation mode in 60% of the NICUs. Permissive hypercapnia is a common practice. Higher SpO2 target limits have been adopted, although alarm settings vary across NICUs. Caffeine is routinely started (96%). Surfactant is used in all NICUs, mostly rescue (74%) via less invasive administration (81%). Prophylactic inhaled nitric oxide (iNO) is not used. Treatment of patent ductus arteriosus (PDA) varies; half of NICUs pharmacologically treat PDA early, based on echocardiographic findings. Ureaplasma screening is done in 22% of NICUs. Most (97%) NICUs use postnatal corticosteroids, with dexamethasone being the preferred drug (65%) and starting 2-3 weeks after birth. Only 5% use corticosteroids prophylactically. After 2-3 weeks, diuretics are used frequently, inhaled corticosteroids/bronchodilators to a much lesser extent. Conclusion. This large survey shows considerable practice variation in preventing and treating evolving BPD across Europe, especially for interventions with limited evidence.