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Inflation times during resuscitation of preterm infants
Vadivelam Murthy1, Natasha Creagh, Janet L Peacock
1Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK.
Insights
Prolonging inflation times during resuscitation of premature infants does not improve ventilation. Extended inflation did not result in longer inflation flow times, suggesting no benefit for ventilation in these vulnerable newborns.
Area of Science:
- Neonatal Resuscitation
- Pediatric Respiratory Physiology
Background:
- Limited data exists on prolonged inflation times during neonatal resuscitation.
- Previous studies have shown conflicting results regarding the effects of prolonged inflation on bronchopulmonary dysplasia (BPD) rates in premature infants.
Purpose of the Study:
- To evaluate the duration of inflation times used in face mask and t-piece resuscitation for premature infants.
- To determine if prolonged inflation times correlate with extended inflation flow times during resuscitation.
Main Methods:
- Utilized a respiration monitor (NM3) to record airflow, airway pressure, and tidal volume.
- Analyzed the first five inflations from 40 prematurely born infants (gestational age 26-32 weeks).
- Assessed the relationship between inflation time, inflation pressure, and inflation flow time.
Main Results:
- Median inflation pressure was 17.6 cm H2O, inflation time 0.89 s, expiratory tidal volume 1.01 ml/kg, and inflation flow time 0.11 s.
- No significant correlation was found between inflation time and inflation flow time.
- A significant relationship was observed between inflation pressure and inflation flow time (p=0.024).
Conclusions:
- Prolonging inflation times during face mask resuscitation of premature infants is unlikely to enhance ventilation.
- The findings suggest that ventilation improvements are not achieved through extended inflation durations in this population.
Unlabelled:
Data on the effects of a prolonged inflation time during the resuscitation of very prematurely born infants are limited; one study showed no effect, and in another, although lower bronchopulmonary dysplasia (BPD) rates were seen, that effect could have been due to the prolonged inflation time, the positive end expiratory pressure applied or the combination of the two. The aims of our study were to assess the length of inflation times used during face mask and t-piece resuscitation of prematurely born infants in the labour suite and determine whether prolonged inflations led to longer inflation flow times. A respiration monitor (NM3 respiratory profile monitor) was used to record flow, airway pressure and tidal volume changes. The first five inflations for each baby were analysed. Forty prematurely born infants (median gestational age 30, range 26-32 weeks) were examined. Their median inflation pressure was 17.6 (range 12.2-27.4) cm H2O, inflation time 0.89 (range 0.33-2.92) s, expiratory tidal volume 1.01 (range 0.02-11.41) ml/kg and inflation flow time 0.11 (range 0.04-0.54) s. There was no significant relationship between the inflation time and the inflation flow time, but there was a significant relationship between the inflation pressure and the inflation flow time (p = 0.024).
Conclusion:
These results suggest that prolonging inflation times during face mask resuscitation of prematurely born infants would not improve ventilation as prolonged inflation did not lead to longer inflation flow times.
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