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).

Physiological responses to facemask application in newborns immediately after birth

2020 ◽  
pp. fetalneonatal-2020-320198
Author(s):  
Vincent D Gaertner ◽  
Christoph Martin Rüegger ◽  
Eoin O'Currain ◽  
C Omar Farouk Kamlin ◽  
Stuart B Hooper ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Randomised Trial ◽  
Healthcare Providers ◽  
Newborn Infants ◽  
Face Mask ◽  
Late Preterm ◽  
Late Preterm Infants ◽  
Trigeminocardiac Reflex ◽  
Prospective Randomised Trial ◽  
Single Centre Study

ObjectiveApplication of a face mask may induce apnoea and bradycardia, possibly via the trigeminocardiac reflex (TCR). We aimed to describe rates of apnoea and bradycardia in term and late-preterm infants following facemask application during neonatal stabilisation and compare the effects of first facemask application with subsequent applications.DesignSubgroup analysis of a prospective, randomised trial comparing two face masks.SettingSingle-centre study in the delivery roomPatientsInfants>34 weeks gestational age at birthMethodsResuscitations were video recorded. Airway flow and pressure were measured using a flow sensor. The effect of first and subsequent facemask applications on spontaneously breathing infants were noted. When available, flow waveforms as well as heart rate (HR) were assessed 20 s before and 30 s after each facemask application.ResultsIn total, 128 facemask applications were evaluated. In eleven percent of facemask applications infants stopped breathing. The first application was associated with a higher rate of apnoea than subsequent applications (29% vs 8%, OR (95% CI)=4.76 (1.41–16.67), p=0.012). On aggregate, there was no change in median HR over time. In the interventions associated with apnoea, HR dropped by 38bpm [median (IQR) at time of facemask application: 134bpm (134–150) vs 96bpm (94–102) 20 s after application; p=0.25] and recovered within 30 s.ConclusionsFacemask applications in term and late-preterm infants during neonatal stabilisation are associated with apnoea and this effect is more pronounced after the first compared with subsequent applications. Healthcare providers should be aware of the TCR and vigilant when applying a face mask to newborn infants.Trial registration numberACTRN12616000768493.

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.

Apnea duration is related to ventilatory oscillation characteristics in newborn infants

1984 ◽  
Vol 57 (2) ◽  
pp. 536-544 ◽  
Author(s):  
T. B. Waggener ◽  
A. R. Stark ◽  
B. A. Cohlan ◽  
I. D. Frantz
Keyword(s):  
Premature Infants ◽  
Newborn Infants ◽  
Face Mask ◽  
Full Term ◽  
Minimum Phase ◽  
Breathing Patterns ◽  
Term Infants ◽  
Apnea Duration ◽  
Band Pass ◽  
The Relationship

The occasional short apneas seen in full-term infants within the first postnatal week are related to the minimum phase of oscillatory breathing patterns. To determine the relationship between breathing patterns and the longer and more frequent apneas seen in premature infants, we monitored respiration in 14 premature infants using a face mask and pneumotachograph. Tidal volume, breath duration, and ventilation were calculated on a breath by breath basis, converted to time-axis data strings, and filtered with a comb of zero phase shift digital band pass filters to detect breathing patterns. Compared with full-term infants, premature infants had breathing patterns that occurred more often and had twice the average amplitude. Of 182 apneas greater than or equal to 3 s long, 94% occurred at the minimum phase of oscillatory breathing patterns. All of the 38 apneas greater than or equal to 10 s long occurred at the minimum phase of oscillatory breathing patterns. Duration of apnea was related to breathing pattern characteristics, e.g., longer apneas were related to stronger, longer cycle-time breathing patterns. Apnea in the premature infant is not an isolated event but is one aspect of an underlying pattern.

scholarly journals Neonatal resuscitation using a laryngeal mask airway: a randomised trial in Uganda

2017 ◽  
Vol 103 (3) ◽  
pp. 255-260 ◽  
Author(s):  
Nicolas J Pejovic ◽  
Daniele Trevisanuto ◽  
Clare Lubulwa ◽  
Susanna Myrnerts Höök ◽  
Francesco Cavallin ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Laryngeal Mask Airway ◽  
Low Income ◽  
Spontaneous Breathing ◽  
Randomised Trial ◽  
Neonatal Resuscitation ◽  
Face Mask ◽  
Laryngeal Mask ◽  
Positive Pressure ◽  
Link Type

ObjectiveMortality rates from birth asphyxia in low-income countries remain high. Face mask ventilation (FMV) performed by midwives is the usual method of resuscitating neonates in such settings but may not always be effective. The i-gel is a cuffless laryngeal mask airway (LMA) that could enhance neonatal resuscitation performance. We aimed to compare LMA and face mask (FM) during neonatal resuscitation in a low-resource setting.SettingMulago National Referral Hospital, Kampala, Uganda.DesignThis prospective randomised clinical trial was conducted at the labour ward operating theatre. After a brief training on LMA and FM use, infants with a birth weight >2000 g and requiring positive pressure ventilation at birth were randomised to resuscitation by LMA or FM. Resuscitations were video recorded.Main outcome measuresTime to spontaneous breathing.ResultsForty-nine (24 in the LMA and 25 in the FM arm) out of 50 enrolled patients were analysed. Baseline characteristics were comparable between the two arms. Time to spontaneous breathing was shorter in LMA arm than in FM arm (mean 153 s (SD±59) vs 216 s (SD±92)). All resuscitations were effective in LMA arm, whereas 11 patients receiving FM were converted to LMA because response to FMV was unsatisfactory. There were no adverse effects.ConclusionA cuffless LMA was more effective than FM in reducing time to spontaneous breathing. LMA seems to be safe and effective in clinical practice after a short training programme. Its potential benefits on long-term outcomes need to be assessed in a larger trial.Clinical trial registryThis trial was registered in https://clinicaltrials.gov, with registration number NCT02042118.

The Platelet of the Newborn Infant – Adenine Nucleotide Metabolism and Release

1980 ◽  
Vol 43 (02) ◽  
pp. 099-103 ◽  
Author(s):  
J M Whaun ◽  
P Lievaart ◽  
Keyword(s):  
Newborn Infant ◽  
Adenine Nucleotide ◽  
Platelet Rich Plasma ◽  
Adenine Nucleotides ◽  
Newborn Infants ◽  
Specific Radioactivity ◽  
Nucleotide Metabolism ◽  
Breakdown Product ◽  
Term Infants ◽  
Adenine Nucleotide Metabolism

SummaryBlood from normal full term infants, mothers and normal adults was collected in citrate. Citrated platelet-rich plasma was prelabelled with 3H-adenine and reacted with release inducers, collagen and adrenaline. Adenine nucleotide metabolism, total adenine nucleotide levels and changes in sizes of these pools were determined in platelets from these three groups of subjects.At rest, the platelet of the newborn infant, compared to that of the mother and normal adult, possessed similar amounts of adenosine triphosphate (ATP), 4.6 ± 0.2 (SD), 5.0 ± 1.1, 4.9 ± 0.6 µmoles ATP/1011 platelets respectively, and adenosine diphosphate (ADP), 2.4 ± 0.7, 2.8 ± 0.6, 3.0 ± 0.3 umoles ADP/1011 platelets respectively. However the marked elevation of specific radioactivity of ADP and ATP in these resting platelets indicated the platelet of the neonate has decreased adenine nucleotide stores.In addition to these decreased stores of adenine nucleotides, infant platelets showed significantly impaired release of ADP and ATP on exposure to collagen. The release of ADP in infants, mothers, and other adults was 0.9 ± 0.5 (SD), 1.5 ± 0.5, 1.5 ± 0.1 umoles/1011 platelets respectively; that of ATP was 0.6 ± 0.3, 1.0 ± 0.1,1.3 ± 0.2 µmoles/1011 platelets respectively. With collagen-induced release, platelets of newborn infants compared to those of other subjects showed only slight increased specific radioactivities of adenine nucleotides over basal levels. The content of metabolic hypoxanthine, a breakdown product of adenine nucleotides, increased in both platelets and plasma in all subjects studied.In contrast, with adrenaline as release inducer, the platelets of the newborn infant showed no adenine nucleotide release, no change in total ATP and level of radioactive hypoxanthine, and minimal change in total ADP. The reason for this decreased adrenaline reactivity of infant platelets compared to reactivity of adult platelets is unknown.Infant platelets may have different membranes, with resulting differences in regulation of cellular processes, or alternatively, may be refractory to catecholamines because of elevated levels of circulating catecholamines in the newborn period.

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