The first breath during resuscitation of prematurely born infants

Area of Science:

• Neonatal Resuscitation
• Respiratory Physiology
• Perinatal Medicine

Background:

• Initial inflation pressures and times in premature infant resuscitation are often suboptimal.
• These low pressures rarely achieve adequate tidal volumes, often not exceeding anatomical dead space.
• Active infant inspiration during resuscitation can increase delivered volumes.

Purpose of the Study:

• To identify factors associated with a reduced time to the first active inflation in prematurely born infants.
• To investigate the relationship between initial resuscitation parameters and the onset of spontaneous respiratory effort.

Main Methods:

• Respiratory function monitoring was employed during resuscitation.
• Peak inflation pressures (PIP), inflation durations, and infant respiratory activity were recorded simultaneously.
• Data from 47 infants with gestational age < 34 weeks requiring resuscitation were analyzed.

Main Results:

• The median time to the first active inflation was 7 seconds.
• A shorter time to the first active inflation was inversely correlated with both the PIP and inflation time of the first five inflations (p=0.001 and p=0.018, respectively).
• Similarly, the PIP and inflation time of the first active inflation were also inversely correlated with the time to achieve it (p=0.001 and p=0.008, respectively).

Conclusions:

• The magnitude of early inflation pressures and durations during neonatal resuscitation is inversely related to the time to the first breath.
• Optimizing initial inflation parameters may facilitate earlier active respiratory effort in premature neonates.