ABSTRACT
During the coronavirus disease 2019 (COVID-19) global pandemic, there has been a need to develop surge capacity. Since the disease is uncommon in children, working on a paediatric intensive care unit (PICU) has required an expansion of roles and responsibilities outside established confines. The most drastic change in practice involved having to care for both critically ill adults and children side by side on the PICU. Redeployment to work on an adult critical care unit as required was similarly momentous. Based on our experience of managing this surge in one of the UK's worst hit tertiary hospitals, we are sharing our reproducible approaches that benefitted trainees. This will be relevant to paediatricians globally who are assisting in critical care strategies and future pandemic planning.
Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Intensive Care Units, Pediatric , Pandemics , Pediatrics/education , SARS-CoV-2 , Adult , Child , Critical Care , Critical Illness , Education, Medical, Graduate , Humans , Tertiary Care Centers , United Kingdom/epidemiologyABSTRACT
AIM: This study reviews clinical outcomes after initiating a routine policy of preterm respiratory stabilisation using nasal high flow (HF) in the delivery room (DR). METHOD: This was a retrospective observational cohort study in a single-centre neonatal intensive care unit and included all neonates born before 32 weeks of gestation between 1 April 2015 and 31 March 2020. Stabilisation measures and outcomes were recorded including oxygen requirements, admission temperature, surfactant administration, invasive ventilation within 72 h of birth, bronchopulmonary dysplasia (BPD) and death. RESULTS: There were 491 eligible babies during the 5-year epoch. 292 were stabilised using HF in the DR. The median admission temperature in babies transferred on HF was 36.8°C, and the median FiO2 at admission was 25%. 45% of these infants received surfactant. At 72 postnatal hours, 78% were either sustained on HF or were either self-ventilating in air (SVIA) or receiving low-flow nasal cannula (LFNC) respiratory support. 27% were intubated within 7 days. At 36 weeks postmenstrual age, 36% of survivors had BPD. CONCLUSION: We have demonstrated that preterm babies <32 weeks can be effectively stabilised on HF in the DR.
