Positive End-Expiratory Pressure in Newborn Resuscitation Around Term: A Randomized Controlled Trial

Area of Science:

• Neonatal Resuscitation
• Pediatric Cardiology
• Respiratory Physiology

Background:

• International guidelines recommend positive end-expiratory pressure (PEEP) for preterm newborn resuscitation.
• Reliable PEEP valves for self-inflating bags are scarce, and PEEP's effects on term newborns are understudied.

Purpose of the Study:

• To determine if a new PEEP valve improves heart rate response during bag-mask resuscitation of term and near-term newborns.

Main Methods:

• A randomized controlled trial was conducted in Tanzania involving 417 newborns.
• Midwives used self-inflating bags with or without a new integrated PEEP valve.
• Heart rate response via ECG was the primary outcome measure.

Main Results:

• No significant difference in heart rate response was observed between groups.
• The PEEP group received lower tidal volumes and had borderline lower expired CO2.
• Twenty-four-hour mortality was 9% in both the PEEP and no-PEEP groups.

Conclusions:

• The PEEP valve delivered a median PEEP within the intended range.
• No evidence supports improved heart rate response with PEEP during resuscitation of term newborns.
• Routine use of PEEP in this population is not supported by these findings.