Introduction: With the advent of technological advancement and better scientific understanding it is possible now to successfully resuscitate and save babies born at less than 500 grams. Stabilization of these infants in the delivery room (DR) is one of the goals of the golden hour management. While some factors, including temperature management and airway care have standards, there is paucity of data on the optimal peak inspiratory pressure (PIP). The Neonatal Resuscitation Program (NRP) recommends using the same inflation pressure of 20 cm to 25 cm H2O for preterm infants as used for term infants. Preterm lungs are not the same as term infants. Due to the smaller lung volume, capacities and dynamic pulmonary mechanics, these preterm infants are prone to pulmonary complications including pneumothorax. Therefore, there is need to use PIP judiciously in the DR.
Methods and Results: In this brief report we present two cases of newborn infants that were born at less than 500 grams and were successfully resuscitated with a lower PIP. The success criteria in the DR were heart rate greater than 100 per minute and adequate oxygen saturations minute by minute per NRP guidelines with minimal use of supplemental oxygen.
Conclusion: While we need good prospectively designed studies to document the ideal PIP for these extreme preterm infants, we suggest a PIP lower than the currently recommended may be sufficient for some extremely preterm infants.
Recommendations in the face of uncertainty: should extremely preterm infants receive chest compressions and/or epinephrine in the delivery room?
