Article Text

Download PDFPDF
Trends in the use of non-invasive respiratory support for term infants in tertiary neonatal units in Australia and New Zealand
  1. Brett J Manley1,2,3,
  2. Adam G Buckmaster4,5,
  3. Javeed Travadi5,
  4. Louise S Owen1,2,3,
  5. Calum T Roberts6,7,8,
  6. Ian M R Wright5,9,10,
  7. Peter G Davis1,2,3,
  8. Gaston Arnolda11,12
  9. and the Australian and New Zealand Neonatal network (ANZNN)
    1. 1 Department of Newborn Research, The Royal Women's Hospital, Parkville, Victoria, Australia
    2. 2 Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
    3. 3 Murdoch Children’s Research Institute, Parkville, Victoria, Australia
    4. 4 Women, Children and Families, Central Coast Local Health District, Gosford, New South Wales, Australia
    5. 5 School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
    6. 6 Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
    7. 7 Monash Newborn, Monash Children’s Hospital, Melbourne, Victoria, Australia
    8. 8 The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
    9. 9 School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
    10. 10 College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
    11. 11 Australian Institute of Health Innovation, Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
    12. 12 School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
    1. Correspondence to Dr Brett J Manley, Department of Newborn Research, The Royal Women's Hospital, Parkville, Victoria, Australia; brett.manley{at}


    Objective To determine whether the use of non-invasive respiratory support, such as continuous positive airway pressure and nasal high flow, to treat term infants in Australian and New Zealand tertiary neonatal intensive care units (NICUs) has changed over time, and if so, whether there are parallel changes in short-term respiratory morbidities.

    Design Retrospective database review of patient-level data from the Australian and New Zealand Neonatal Network (ANZNN) from 2010 to 2018. Denominator data on the number of term inborn livebirths in each facility was only available as annual totals.

    Patients and setting Term, inborn infants cared for in NICUs within the ANZNN.

    Main outcome measures The primary outcome was the annual change in hospital-specific rates of non-invasive respiratory support per 1000 inborn livebirths, expressed as a percentage change. Secondary outcomes were the change in rates of mechanical ventilation, pneumothorax requiring drainage, exogenous surfactant treatment and death before hospital discharge.

    Results A total of 14 656 term infants from 21 NICUs were included from 2010 to 2018, of whom 12 719 received non-invasive respiratory support. Non-invasive respiratory support use increased on average by 8.7% per year (95% CI: 7.9% to 9.4% per year); the number of term infants receiving non-invasive respiratory support almost doubled from 980 in 2010 (10.8/1000 livebirths) to 1913 in 2018 (20.8/1000). There was no change over time in rate of mechanical ventilation or death. The rate of pneumothorax requiring drainage increased over time, as did surfactant treatment.

    Conclusions Non-invasive respiratory support use to treat term infants cared for in NICUs within the ANZNN is increasing over time. Clinicians should be diligent in selecting infants most likely to benefit from treatment with non-invasive respiratory support in this relatively low-risk population of term newborn infants. Analysis of patient-level data by individual NICUs is recommended to control for potential confounding due to changes in population over time.

    • neonatology
    • intensive care units, neonatal
    • paediatrics

    Data availability statement

    Data may be obtained from a third party and are not publicly available.

    Statistics from

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    Data may be obtained from a third party and are not publicly available.

    View Full Text


    • Twitter @calumtheroberts

    • Contributors BJM, AB and GA led the project, all authors conceived and planned the manuscript and analysis. GA performed all of the data analysis. BJM wrote the first draft of the manuscript. AB, GA and PGD revised the manuscript. BJM is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests BJM, LSO, CTR and PGD and their research activities are supported by Medical Research Future Fund (MRFF, Australia) or National Health and Medical Research Council (NHMRC, Australia) fellowships and grants.

    • Provenance and peer review Not commissioned; externally peer reviewed.