Initial stabilisation of preterm infants: a new resuscitation system with low imposed work of breathing for use with face mask or nasal prongs

Abstract

Compared with T-piece systems, the new system had a marked reduction in iWOB in bench tests. The feasibility trial did not reveal problems with usability or safety.

T-piece resuscitators: how do they compare?

“…However, its use to produce PEEP during IPPV at newborn resuscitation is a new method with only one clinical feasibility trial to date 22. We have shown significant advantages of this design over a range of current TPR devices with regard to the production of device generated inadvertent PEEP.…”

“…Donaldsson et al 22 in 2017 detailed a resuscitation system for newborns that uses a newly designed dual flow ratio valve to provide PEEP during PPV or CPAP. This new system has the facility to change the patient interface between face mask and nasal prongs while maintaining the ability to provide PPV.…”

Supporting breathing of preterm infants at birth: a narrative review

“…The authors stated that these factors combined could lead to a high work of breathing (WOB) 40–42. To reduce WOB, Donaldsson et al 43 developed a novel ventilator system that reduced the WOB during expiration. In a bench test, they reported higher pressure stability and lower WOB when using the novel device with masks or nasal prongs compared with the Neopuff.…”

“…There is no further clinical data comparing CPAP devices in the delivery room, except that Donaldson et al 43 compared the novel resuscitation device using facemask and nasal prongs with the Neopuff in a randomised feasibility trial including 36 infants 27–34 weeks of gestation. There were no differences in study outcomes; the results were difficult to interpret given the large differences in gestational age (231±9.9 vs 228±10.7 vs 215±16.9 days) between groups.…”

Devices used for stabilisation of newborn infants at birth

“…Compared with FMs, nasal tubes were found inferior as interfaces for stabilisation of very preterm infants 31. However, a very recent pilot study found that a binasal continuous positive airway pressure (CPAP) driver modified to deliver intermittent positive pressure ventilation (IPPV) was also suitable for delivering peak inspiratory pressure (PIP) and positive end-expiratory pressure (PEEP) while having a low resistance breathing circuit 33. This interface needs to be studied in a larger clinical trial.…”