Sick babies at risk from lack of breathing tube monitoring

By Nazima Pathan
Science fellow

image copyrightScience Photo Library
image captionAbout 120,000 babies and children are admitted to paediatric or neonatal intensive care units each year

Some intensive care units may be putting sick babies at risk by not monitoring breathing tubes correctly, according to a study which interviewed staff at hospitals across the country.

This could lead to death or serious harm to babies from lack of oxygen, the researchers said.

Doctors needed to be better prepared and have the best equipment to place breathing tubes safely, they said.

The charity Bliss urged hospitals to act on the recommendations.

The study, led by doctors at the Royal United Hospitals Bath NHS Foundation Trust, interviewed staff at 27 paediatric and 129 neonatal intensive care units across the country.

It found that less than half of specialist baby units had the equipment to measure carbon dioxide (capnography) coming from the lungs.

Measuring this gas helps doctors work out if the tube is in the correct position in the airway, and not the throat.

In contrast, units dealing with older babies and children were found to be routinely measuring carbon dioxide.

'Important technology'

The researchers found that without proper monitoring, death or serious harm during intubation had occurred in 26% of the neonatal units and 19% of the paediatric units in the past five years - equivalent to 34 neonatal units and five paediatric units.

About 120,000 babies and children are admitted to paediatric or neonatal intensive care units each year in the UK.

image copyrightScience Photo Library

While doctors who place airways in children are highly trained, patients can sometimes have differences in the anatomy of mouth and airway that makes the process of intubating more challenging.

Prof Tim Cook, one of the authors of the study, said: "We hope that the neonatal units where capnography is already being used can share best practice with other colleagues to help implement this important technology more widely.

"In the case of low-weight neonates, more research is needed to establish whether measuring carbon dioxide is useful and improves care."

'Highest standard of care'

Caroline Lee-Davey, chief executive of the premature and sick baby charity Bliss, said: "It is extremely important that the recommendations of this crucial research are taken on board by NHS trusts across the country in order to ensure that babies on neonatal units receive the highest possible standard of care.

"The forthcoming NHS England Neonatal Review should incorporate these recommendations as part of its wider programme to improve staffing and consistency of care across neonatal units."

Neonatologist Dr Helen Mactier, speaking on behalf of the Royal College of Paediatrics and Child Health, said it was important to identify the best equipment for monitoring preterm babies needing intubation.

"It is not clear from the study if centres that deal with higher risk pregnancies were better prepared than low risk birth units," she said.

"Antenatal identification of women whose baby might need intensive care helps to ensure they are cared for in a unit that is best equipped to deal with sick babies needing intubation."

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