Effects of Breathing and Apnoea during Sustained Inflations in Resuscitation of Preterm Infants

Abstract

Background: A sustained inflation (SI) at birth in preterm babies may be ineffective unless the infants breathe. Gain in lung volume is associated with breathing during delivery room non-invasive management. Objective: To describe the breathing patterns of preterm infants during an SI and correlate to a calculated gain in lung volume. Methods: Retrospective observational study. Data collected from a respiratory function monitor during SI (25 cmH₂O for 15 s then PEEP at 5 cmH₂O) through a face mask in preterm infants (gestational age [GA] ≤31 weeks). Spontaneous breaths, inspiratory time (TI), inspiratory/expiratory tidal volume (Vti/Vte), and gain in lung volume were determined. Results: 30 SIs in 20 infants (mean GA 27 weeks; birth weight 825 g) were analysed and stratified in 2 groups according to spontaneous breathing: SIs without spontaneous breaths (apnoea: n = 11) and SIs with spontaneous breaths (breathing: n = 19). Mean GA was lower in the apnoea group versus the breathing group (25 vs. 27⁺⁵ weeks; p = 0.01). Mean birth weight was lower in the apnoea group versus the breathing group (683 vs. 860 g; p = ns). In the breathing group, the mean number of spontaneous breaths was 4 with a mean TI of 0.52 min, the mean Vti/kg was 5.9 mL/kg, and the mean Vt_e was 2.7 mL/kg. The calculated mean gain in lung volume was 7.5 mL/kg in the apnoea group and 17.8 mL/kg in the breathing group (p = 0.039). Conclusions: Actively breathing infants during an SI at birth showed a gain in lung volume higher than apnoeic infants. Spontaneous breathing during SI seems to be related to GA.

Sustained lung inflation at birth via short binasal prong in very low birth weight preterm infants: A retrospective study

“…Previous studies have shown that substantial leakage from neonatal masks during neonatal resuscitation and SLI significantly inhibited the efficacy of SLI . Similarly, SLI is unlikely to be effective in infants with apnea because the glottis is closed . Furthermore, we used the LISA method when infants in the study and control group required surfactant, which might have a positive effect on the study group overall.…”

“…Nearly all of the studies investigating the efficacy of SLI have used neonatal face‐masks as the interface . However, the use of neonatal face‐masks for both SLI and IPPV has been associated with significant air leakage or airway obstruction, thus reducing the effectiveness of the procedure . Studies in the literature have focused more on SLI as a rescue maneuver in preterm infants; only the studies by Lista et al evaluated prophylactic SLI in infants with high risk of respiratory distress syndrome (RDS).…”

Respiratory Distress Syndrome Management in Delivery Room

“…Sustained inflation can be delivered with a face mask or through an endotracheal tube. However, effects on infants [31,32] using face masks have shown to be less impressive than using a tube in animal models [33], probably because of the tendency toward active closure of the glottis in infants during apnea or hypoxia [34,35].…”

“…A potential method could be end-tidal CO 2 (ETCO 2 ) monitoring, which have shown to be feasible to guide length of SI during resuscitation [38]. Also, the effectiveness of SI maneuver can be largely influenced by several factors, such as the different skill of the clinical team, interface through which a SI is delivered [39], the infant's respiratory effort [35] and mask leak [32]. Given these findings, SI might not be the optimal approach in all apneic infants.…”

Sustained Lung Inflations During Neonatal Resuscitation at Birth: A Meta-analysis

“…[8][9][10][11][12][13][14] Researchers of multiple observational studies have shown that SI at birth is associated with a reduction in delivery room intubations, improved heart rate, and reduced duration of mechanical ventilation. 1,[15][16][17][18][19][20][21][22] However, in other observational studies, researchers have questioned the effectiveness of SI in infants who do not take spontaneous breaths. [23][24][25] Internationally, guidelines vary in recommendations regarding the inflation time and pressure for the first few breaths.…”