The first five inflations during resuscitation of prematurely born infants

TY - JOUR

T1 - The first five inflations during resuscitation of prematurely born infants

AU - Murthy, Vadivelam

AU - Dattani, Nikesh

AU - Peacock, Janet L.

AU - Fox, Grenville

AU - Campbell, Morag E.

AU - Milner, Anthony D.

AU - Greenough, Anne

PY - 2012/7

Y1 - 2012/7

N2 - Objective: To study the first five inflations during the resuscitation of prematurely born infants and whether the infant's inspiratory efforts influenced the expired tidal volume. Design: Prospective observational study. Setting: Two tertiary perinatal centres. Patients: Thirty infants, median gestational age 30 (23-34) weeks. Interventions: The first five inflations delivered via a face mask and t-piece device were examined using respiratory function monitoring. Main outcome measures: Inflation pressures, inflation times and expiratory volumes were recorded and comparison made of inflations during which the infant made an inspiratory effort (active inflation) or did not (passive inflation). Results: Overall, the median expired tidal volume was 2.5 (0-19.8) ml/kg and was lower for passive (median 2.1 ml/kg, range 0-19.8 ml/kg) compared with active (median 5.6 ml/kg, range 1.2-12.2 ml/kg) inflations (ratio of geometric means 1.85, 95% Cl 1.18 to 28%) (p=0.007). Overall, the median face mask leak was 54.5% and was lower for active (34.5%) compared with passive (60.7%) inflations (mean difference in % leak: 12.4%, 95% Cl 0.9 to 24%) (p=0.0354). There was a significant positive correlation between the expiratory volumes and the inflation pressures (82 between subjects 0.19, p=0.04) and a negative correlation between the expiratory tidal volumes and the face mask leaks (82 between subjects=0.051, p<0.001), but there was no significant correlation between the inflation times and the expiratory tidal volumes. Conclusion: The expired tidal volume, inflation pressures and times during the first five inflations during resuscitation were variable. The expired tidal volumes were significantly greater if the infant inspired during the inflation.

AB - Objective: To study the first five inflations during the resuscitation of prematurely born infants and whether the infant's inspiratory efforts influenced the expired tidal volume. Design: Prospective observational study. Setting: Two tertiary perinatal centres. Patients: Thirty infants, median gestational age 30 (23-34) weeks. Interventions: The first five inflations delivered via a face mask and t-piece device were examined using respiratory function monitoring. Main outcome measures: Inflation pressures, inflation times and expiratory volumes were recorded and comparison made of inflations during which the infant made an inspiratory effort (active inflation) or did not (passive inflation). Results: Overall, the median expired tidal volume was 2.5 (0-19.8) ml/kg and was lower for passive (median 2.1 ml/kg, range 0-19.8 ml/kg) compared with active (median 5.6 ml/kg, range 1.2-12.2 ml/kg) inflations (ratio of geometric means 1.85, 95% Cl 1.18 to 28%) (p=0.007). Overall, the median face mask leak was 54.5% and was lower for active (34.5%) compared with passive (60.7%) inflations (mean difference in % leak: 12.4%, 95% Cl 0.9 to 24%) (p=0.0354). There was a significant positive correlation between the expiratory volumes and the inflation pressures (82 between subjects 0.19, p=0.04) and a negative correlation between the expiratory tidal volumes and the face mask leaks (82 between subjects=0.051, p<0.001), but there was no significant correlation between the inflation times and the expiratory tidal volumes. Conclusion: The expired tidal volume, inflation pressures and times during the first five inflations during resuscitation were variable. The expired tidal volumes were significantly greater if the infant inspired during the inflation.

KW - Inhalation

KW - Perinatal Care

KW - Humans

KW - Gestational Age

KW - Infant, Newborn

KW - Monitoring, Physiologic

KW - Infant, Premature

KW - Resuscitation

KW - Tidal Volume

KW - Masks

KW - Prospective Studies

KW - Positive-Pressure Respiration

KW - Female

KW - Male

U2 - 10.1136/archdischild-2011-300117

DO - 10.1136/archdischild-2011-300117

M3 - Article

C2 - 22174020

SN - 1359-2998

VL - 97

SP - F249-F253

JO - Archives of Disease in Childhood Fetal and Neonatal Edition

JF - Archives of Disease in Childhood Fetal and Neonatal Edition

IS - 4

ER -