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Evaluating manual inflations and breathing during mask ventilation in preterm infants at birth
Kim Schilleman1, Corinne J M van der Pot, Stuart B Hooper
1Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands. kimschilleman86@gmail.com
Insights
Mask ventilation for preterm infants often has leaks, leading to low expiratory tidal volume (V(Te)). Most infants breathe during ventilation, which likely aids stabilization after birth.
Area of Science:
- Neonatal Resuscitation
- Pediatric Respiratory Support
Background:
- Mask ventilation is crucial for preterm infants at birth.
- Understanding ventilation mechanics is key to optimizing outcomes.
Purpose of the Study:
- To analyze inflations and infant breathing during mask ventilation in preterm neonates.
- To assess expiratory tidal volume (V(Te)) and identify common ventilation issues.
Main Methods:
- Recorded mask ventilation during resuscitation for infants <32 weeks' gestation.
- Analyzed inflation types, breathing patterns, and V(Te).
- Evaluated for mask leak, low/high V(Te), and airway obstruction.
Main Results:
- Large mask leak frequently caused low V(Te).
- 89% of infants breathed during positive pressure ventilation.
- Infant breaths had significantly lower V(Te) compared to inflations.
Conclusions:
- Significant mask leak and low V(Te) were common, particularly during sustained inflations.
- Spontaneous breathing during mask ventilation likely supports infant stabilization post-birth.
Objective:
To investigate inflations (initial sustained inflations and consecutive inflations) and breathing during mask ventilation in preterm infants at birth.
Study Design:
Resuscitation of infants <32 weeks' gestation receiving mask ventilation at birth were recorded. Recorded waveforms were divided into inflations (sustained and consecutive inflations), breaths in between inflations, breaths coinciding with an inflation, and breaths on continuous positive airway pressure (during evaluation moments in between and after ventilation) and expiratory tidal volume (V(Te)) was compared. Inflations were analyzed for leak, low V(Te) (<2.5 mL/kg), high V(Te) (>15 mL/kg in sustained inflations, >10 mL/kg in consecutive inflations), and airway obstruction.
Results:
In 27 infants, we analyzed 1643 inflations, 110 breaths in between inflations, 133 breaths coinciding with an inflation, and 1676 breaths on continuous positive airway pressure. A large mask leak frequently resulted in low V(Te). Breathing during positive pressure ventilation occurred in 24 of 27 infants (89%). Median (IQR) V(Te) of inflations, breaths in between inflations, and breaths coinciding with an inflation were 0.8 mL/kg (0.0-5.6 mL/kg), 2.8 mL/kg (0.7-4.6 mL/kg), and 3.9 mL/kg (0.0-7.7 mL/kg) during sustained inflations and 3.7 mL/kg (1.4-6.7 mL/kg), 3.3 mL/kg (2.1-6.6 mL/kg), and 4.6 mL/kg (2.1-7.8 mL/kg) during consecutive inflations, respectively. The V(Te) of breaths were significantly lower than the V(Te) of inflations or breaths coinciding with an inflation.
Conclusions:
We often observed large leak and low V(Te), especially during sustained inflations. Most preterm infants breathe when receiving mask ventilation and this probably contributed to the stabilization of the infants after birth.
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