Optimal Inspired Fraction of Oxygen in the Delivery Room for Preterm Infants

Postnatal adaptation of preterm infants entails a series of difficulties among which the immaturity of the respiratory system is the most vital. To overcome respiratory insufficiency, caregivers attending in the delivery room use positive pressure ventilation and oxygen. A body of evidence in relation of oxygen management in the delivery room has been accumulated in recent years; however, the optimal initial inspired fraction of oxygen, the time to achieve specific oxygen saturation targets, and oxygen titration have not been yet clearly established. The aim of this review is to update the reader by critically analyzing the most relevant literature.

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

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2017-313864 ◽

2018 ◽

Vol 104 (1) ◽

pp. F57-F62 ◽

Cited By ~ 19

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.

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Oxygenation of the Newborn

Donald School Journal of Ultrasound in Obstetrics & Gynecology ◽

10.5005/jp-journals-10009-1462 ◽

2016 ◽

Vol 10 (2) ◽

pp. 170-171 ◽

Cited By ~ 1

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.

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Corrective steps to enhance ventilation in the delivery room

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2019-318579 ◽

2020 ◽

Vol 105 (6) ◽

pp. 605-608 ◽

Cited By ~ 3

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.

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