New Strategies of Pulmonary Protection of Preterm Infants in the Delivery Room with the Respiratory Function Monitoring

2019 ◽  
Vol 36 (13) ◽  
pp. 1368-1376
Author(s):  
Gonzalo Zeballos Sarrato ◽  
Manuel Sánchez Luna ◽  
Susana Zeballos Sarrato ◽  
Alba Pérez Pérez ◽  
Isabel Pescador Chamorro ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Respiratory Function ◽  
Invasive Mechanical Ventilation ◽  
Secondary Analysis ◽  
Newborn Infants ◽  
Delivery Room ◽  
Positive Pressure ◽  
Surfactant Administration ◽  
Pulmonary Protection ◽  
New Strategies

Objective To investigate if the use of a visible respiratory function monitor (RFM) to use lower tidal volumes (Vts) during positive pressure ventilation (PPV) in the delivery room (DR) reduces the need of surfactant administration and invasive mechanical ventilation during the first 72 hours after birth of preterm infants <32 weeks' gestational age (GA). Study Design Infants <32 weeks' GA (n = 106) requiring noninvasive PPV were monitored with a RFM at birth and randomized to visible (n = 54) or masked (n = 52) display on RFM. Pulmonary data were recorded during the first 10 minutes after birth. Secondary analysis stratified patients by GA (<28, 28–29+6, or ≥30 weeks). Results Median expiratory Vts during inflations were greater in the masked group (7 mL/kg) than in the visible group (5.8 mL/kg; p = 0.001) same as peak inflation pressure (PIP) administered (21.5 vs. 19.7 cmH2O; p < 0.001). Consequently, minute volumes were greater in the masked group (256 vs. 214 mL/kg/min; p < 0.001), with no differences in respiratory rate. These differences were higher in those <30 weeks' GA. There was no difference in the need of surfactant administration or intubation during the first 72 hours of age. Conclusion Using a RFM in the DR prevents the use of large Vt and PIP during respiratory support inflations, mostly in the more immature newborn infants, but with no other short-term benefits.

scholarly journals Delivery Room Management of Asphyxiated Term and Near-Term Infants

Neonatology ◽  
2021 ◽  
pp. 1-13
Author(s):  
Marlies Bruckner ◽  
Gianluca Lista ◽  
Ola D. Saugstad ◽  
Georg M. Schmölzer
Keyword(s):  
Preterm Infants ◽  
Newborn Infants ◽  
Neonatal Resuscitation ◽  
Birth Asphyxia ◽  
Delivery Room ◽  
Temperature Management ◽  
Term Infants ◽  
Term Newborn ◽  
Resuscitation Guidelines ◽  
Delivery Room Management

Approximately 800,000 newborns die annually due to birth asphyxia. The resuscitation of asphyxiated term newly born infants often occurs unexpected and is challenging for healthcare providers as it demands experience and knowledge in neonatal resuscitation. Current neonatal resuscitation guidelines often focus on resuscitation of extremely and/or very preterm infants; however, the recommendations for asphyxiated term newborn infants differ in some aspects to those for preterm infants (i.e., respiratory support, supplemental oxygen, and temperature management). Since the update of the neonatal resuscitation guidelines in 2015, several studies examining various resuscitation approaches to improve the outcome of asphyxiated infants have been published. In this review, we discuss current recommendations and recent findings and provide an overview of delivery room management of asphyxiated term newborn infants.

Impact of delivered tidal volume on the occurrence of intraventricular haemorrhage in preterm infants during positive pressure ventilation in the delivery room

2018 ◽  
Vol 104 (1) ◽  
pp. F57-F62 ◽  
Author(s):  
Qaasim Mian ◽  
Po-Yin Cheung ◽  
Megan O’Reilly ◽  
Samantha K Barton ◽  
Graeme R Polglase ◽  
...  
Keyword(s):  
Brain Injury ◽  
Tidal Volume ◽  
Preterm Infants ◽  
Positive Pressure Ventilation ◽  
Intraventricular Haemorrhage ◽  
Delivery Room ◽  
Positive Pressure ◽  
Reference Ranges ◽  
The Mean ◽  
Spontaneously Breathing

Background and objectivesDelivery of inadvertent high tidal volume (VT) during positive pressure ventilation (PPV) in the delivery room is common. High VT delivery during PPV has been associated with haemodynamic brain injury in animal models. We examined if VT delivery during PPV at birth is associated with brain injury in preterm infants <29 weeks’ gestation.MethodsA flow-sensor was placed between the mask and the ventilation device. VT values were compared with recently described reference ranges for VT in spontaneously breathing preterm infants at birth. Infants were divided into two groups: VT<6  mL/kg or VT>6 mL/kg (normal and high VT, respectively). Brain injury (eg, intraventricular haemorrhage (IVH)) was assessed using routine ultrasound imaging within the first days after birth.ResultsA total of 165 preterm infants were included, 124 (75%) had high VT and 41 (25%) normal VT. The mean (SD) gestational age and birth weight in high and normal VT group was similar, 26 (2) and 26 (1) weeks, 858 (251) g and 915 (250) g, respectively. IVH in the high VT group was diagnosed in 63 (51%) infants compared with 5 (13%) infants in the normal VT group (P=0.008).Severe IVH (grade III or IV) developed in 33/124 (27%) infants in the high VT group and 2/41 (6%) in the normal VT group (P=0.01).ConclusionsHigh VT delivery during mask PPV at birth was associated with brain injury. Strategies to limit VT delivery during mask PPV should be used to prevent high VT delivery.

Effects of tactile stimulation on spontaneous breathing during face mask ventilation

2021 ◽  
pp. fetalneonatal-2021-322989
Author(s):  
Vincent D Gaertner ◽  
Christoph Martin Rüegger ◽  
Dirk Bassler ◽  
Eoin O'Currain ◽  
C Omar Farouk Kamlin ◽  
...  
Keyword(s):  
Surface Area ◽  
Tactile Stimulation ◽  
Randomised Trial ◽  
Secondary Analysis ◽  
Newborn Infants ◽  
Face Mask ◽  
Positive Pressure ◽  
Clinical Trial Registry ◽  
Term Infants ◽  
Prospective Randomised Trial

ObjectiveWe sought to determine the effect of stimulation during positive pressure ventilation (PPV) on the number of spontaneous breaths, exhaled tidal volume (VTe), mask leak and obstruction.DesignSecondary analysis of a prospective, randomised trial comparing two face masks.SettingSingle-centre delivery room study.PatientsNewborn infants ≥34 weeks’ gestation at birth.MethodsResuscitations were video recorded. Tactile stimulations during PPV were noted and the timing, duration and surface area of applied stimulus were recorded. Respiratory flow waveforms were evaluated to determine the number of spontaneous breaths, VTe, leak and obstruction. Variables were recorded throughout each tactile stimulation episode and compared with those recorded in the same time period immediately before stimulation.ResultsTwenty of 40 infants received tactile stimulation during PPV and we recorded 57 stimulations during PPV. During stimulation, the number of spontaneous breaths increased (median difference (IQR): 1 breath (0–3); padj<0.001) and VTe increased (0.5 mL/kg (−0.5 to 1.7), padj=0.028), whereas mask leak (0% (−20 to 1), padj=0.12) and percentage of obstructed inflations (0% (0–0), padj=0.14) did not change, compared with the period immediately prior to stimulation. Increased duration of stimulation (padj<0.001) and surface area of applied stimulus (padj=0.026) were associated with a larger increase in spontaneous breaths in response to tactile stimulation.ConclusionsTactile stimulation during PPV was associated with an increase in the number of spontaneous breaths compared with immediately before stimulation without a change in mask leak and obstruction. These data inform the discussion on continuing stimulation during PPV in term infants.Trial registration numberAustralian and New Zealand Clinical Trial Registry (ACTRN12616000768493).

Oxygenation of the Newborn

2016 ◽  
Vol 10 (2) ◽  
pp. 170-171 ◽  
Author(s):  
Ola D Saugstad
Keyword(s):  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
Necrotizing Enterocolitis ◽  
Gestational Age ◽  
Obstet Gynecol ◽  
Positive Pressure Ventilation ◽  
Newborn Infants ◽  
Delivery Room ◽  
Positive Pressure ◽  
Risk Of Mortality

ABSTRACT Newborn infants in need of positive pressure ventilation at birth should initially be given 21% O2 from term to gestational age 33 weeks. Gestational ages 29-32 weeks could be given initially FiO2 of 0.21-0.30. For ≤ 28 weeks FiO2 of 0.30 or more should be given initially. FiO2 should then be adjusted according to the oxygen saturation response assessed by pulse oximetry. After delivery room stabilisation oxygen saturation targets of 85-89% increases the risk of mortality and necrotizing enterocolitis. In spite an oxygen target of 90-95% increases the risk of ROP this is presently the recommended range. How to cite this article Saugstad OD. Oxygenation of the Newborn. Donald School J Ultrasound Obstet Gynecol 2016;10(2):170-171.

scholarly journals 332 Use of a Respiratory Function Monitor During Positive Pressure Ventilation in the Delivery Room -A Randomized Trial

2010 ◽  
Vol 68 ◽  
pp. 171-171
Author(s):  
G M Schmölzer ◽  
C J Morley ◽  
O C Kamlin ◽  
J A Dawson ◽  
S Donath ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Respiratory Function ◽  
Positive Pressure Ventilation ◽  
Delivery Room ◽  
Positive Pressure

Corrective steps to enhance ventilation in the delivery room

2020 ◽  
Vol 105 (6) ◽  
pp. 605-608 ◽  
Author(s):  
Kesi C Yang ◽  
Arjan B te Pas ◽  
Danielle D Weinberg ◽  
Elizabeth E Foglia
Keyword(s):  
Heart Rate ◽  
Tidal Volume ◽  
Preterm Infants ◽  
Prospective Observational Study ◽  
Positive Pressure Ventilation ◽  
Outcome Measure ◽  
Delivery Room ◽  
Positive Pressure ◽  
Mouth Pressure ◽  
Before And After

ObjectiveThe clinical impact of ventilation corrective steps for delivery room positive pressure ventilation (PPV) is not well studied. We aimed to characterise the performance and effect of ventilation corrective steps (MRSOPA (Mask adjustment, Reposition airway, Suction mouth and nose, Open mouth, Pressure increase and Alternative airway)) during delivery room resuscitation of preterm infants.DesignProspective observational study of delivery room PPV using video and respiratory function monitor recordings.SettingTertiary academic delivery hospital.PatientsPreterm infants <32 weeks gestation.Main outcome measureMean exhaled tidal volume (Vte) of PPV inflations before and after MRSOPA interventions, categorised as inadequate (<4 mL/kg); appropriate (4–8 mL/kg), or excessive (>8 mL/kg). Secondary outcomes were leak (>30%) and obstruction (Vte <1 mL/kg), and infant heart rate.ResultsThere were 41 corrective interventions in 30 infants, with a median duration of 15 (IQR 7–29) s. The most frequent intervention was a combination of Mask/Reposition and Suction/Open. Mean Vte was inadequate before 16/41 interventions and became adequate following 6/16. Mean Vte became excessive after 6/41 interventions. Mask leak, present before 13/41 interventions, was unchanged after 4 and resolved after 9. Obstruction was present before five interventions and was subsequently resolved only once. MRSOPA interventions introduced leak in two cases and led to obstruction in one case. The heart rate was <100 beats per minute before 31 interventions and rose to >100 beats per minute after 14/31 of these.ConclusionsVentilation correction interventions improve tidal volume delivery in some cases, but lead to ineffective or excessive tidal volumes in others. Mask leak and obstruction can be induced by MRSOPA manoeuvres.

scholarly journals Oxygen in the First Minutes of Life in Very Preterm Infants

Neonatology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Ola Didrik Saugstad ◽  
Vishal Kapadia ◽  
Ju Lee Oei
Keyword(s):  
Heart Rate ◽  
Relevant Literature ◽  
Newborn Infants ◽  
Adverse Outcomes ◽  
Delivery Room ◽  
Positive Pressure ◽  
Very Preterm Infants ◽  
Liaison Committee ◽  
Very Preterm ◽  
Increased Risk

Even a few minutes of exposure to oxygen in the delivery room in very preterm and immature infants may have detrimental effects. The initial oxygenation in the delivery room should therefore be optimized, but knowledge gaps, including initial fraction of oxygen (FiO<sub>2</sub>) and how FiO<sub>2</sub> should be changed to reach an optimal oxygen saturation measured by pulse oximetry (SpO<sub>2</sub>) target within the first 5–10 min of life, remain. In order to answer this question, we therefore reviewed relevant literature. For newly born infants with gestational age (GA) &#x3c;32 weeks in need of positive pressure ventilation (PPV) immediately after birth, we identified 2 fundamental issues: (1) the optimal initial FiO<sub>2</sub> and (2) the target SpO<sub>2</sub> within the first 5–10 min of life. For newly born infants between 29 and 31 weeks of GA, an initial FiO<sub>2</sub> of 0.3 hit the target defined by the International Liaison Committee on Resuscitation (ILCOR) best. Newborn infants with GA &#x3c;29 weeks in need of PPV and supplementary oxygen, we suggest starting with FiO<sub>2</sub> 0.3 and adjusting the FiO<sub>2</sub> to reach SpO<sub>2</sub> of 80% within 5 min of life for best outcomes. Prolonged bradycardia (heart rate &#x3c;100 bpm for &#x3e;2 min) is associated with increased risk of adverse outcomes, including death. The combination of strict control of development of SpO<sub>2</sub> in the first 10 min of life and a heart rate &#x3e;100 bpm represents the best tool today to achieve the most optimal outcome in the delivery room of very preterm and immature newborn infants.

scholarly journals Time to desaturation in preterm infants undergoing endotracheal intubation

2021 ◽  
pp. fetalneonatal-2020-319509
Author(s):  
Radhika Kothari ◽  
Kate Alison Hodgson ◽  
Peter G Davis ◽  
Marta Thio ◽  
Brett James Manley ◽  
...  
Keyword(s):  
Endotracheal Intubation ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Positive Pressure Ventilation ◽  
Secondary Analysis ◽  
Neonatal Resuscitation ◽  
Physiological Data ◽  
Positive Pressure ◽  
Postmenstrual Age ◽  
Registration Number

BackgroundNeonatal endotracheal intubation is often associated with physiological instability. The Neonatal Resuscitation Program recommends a time-based limit (30 s) for intubation attempts in the delivery room, but there are limited physiological data to support recommendations in the neonatal intensive care unit (NICU). We aimed to determine the time to desaturation after ceasing spontaneous or assisted breathing in preterm infants undergoing elective endotracheal intubation in the NICU.MethodsObservational study at The Royal Women’s Hospital, Melbourne. A secondary analysis was performed of video recordings of neonates ≤32 weeks’ postmenstrual age undergoing elective intubation. Infants received premedication including atropine, a sedative and muscle relaxant. Apnoeic oxygenation time (AOT) was defined as the time from the last positive pressure or spontaneous breath until desaturation (SpO2 <90%).ResultsSeventy-eight infants were included. The median (IQR) gestational age at birth was 27 (26–29) weeks and birth weight 946 (773–1216) g. All but five neonates desaturated to SpO2 <90% (73/78, 94%). The median (IQR) AOT was 22 (14–32) s. The median (IQR) time from ceasing positive pressure ventilation to desaturation <80% was 35 (24–44) s and to desaturation <60% was 56 (42–68) s. No episodes of bradycardia were seen.ConclusionsThis is the first study to report AOT in preterm infants. During intubation of preterm infants in the NICU, desaturation occurs quickly after cessation of positive pressure ventilation. These data are important for the development of clinical guidelines for neonatal intubation.Trial registration numberACTRN12614000709640

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