Endotracheal resuscitation of neonates using a rebreathing bag

Thirty asphyxiated neonates were resuscitated endotracheally with an anaesthetic rebreathing bag. The system was not limited either by pressure or by volume and chest movement was used as the criterion for adequate inflation. Inflation pressure and flow were recorded during resuscitation, and flow was integrated to obtain volume. Median mean pressure over the first 10 inflations was 40 cm H2O and this dropped during later resuscitation to 29 cm H2O. The volume delivered did not change significantly, so volume divided by pressure increased from a median of 0.18 to 0.35 ml/kg/cm H2O. Fourteen infants formed part of their functional residual capacity with artificial ventilation and five with spontaneous breaths. Eleven infants showed no evidence of functional residual capacity formation. In the 22 preterm infants there was a strong association between absence of functional residual capacity formation and later hyaline membrane disease that required ventilation. We suggest that pressures of more than than 30 cm H2O may be helpful during initial resuscitation and that there should be further study of devices using positive end expiratory pressure for resuscitation of preterm infants.