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AIM: To verify the added value of respiratory function monitor (RFM) to assess ventilation and the heart rate (HR) changes during stabilization of preterm infants.METHODS: Preterm infants 100 bpm; T2 the delivery of the last PPV). For each inflation, PIP, PEEP, MAP, expired tidal volume/kg (Vte/kg), and mean dynamic compliance (Cdyn) were analyzed.RESULTS: PIP and MAP values were significantly higher at T1 (27.09 ± 5.37 and 17.47 ± 3.85 cmH2 O) and at T2 (24.7 ± 3.86 and 15.2 ± 3.78 cmH2 O) compared to T0 (24.05 ± 2.27 and 15.85 ± 2.77 cmH2 O). PEEP at T1 was significantly higher (6.27 ± 2.17 cmH2 O) compared to T2 (5.61 ± 1.50 cmH2 O). Vte/kg showed significantly lower T0 values (3.57 ± 2.14 ml/kg) compared to T1 (6.18 ± 2.51 ml/kg) and T2 (6.89 ± 2.40 ml/kg). There was a significant effect of time on Cdyn.CONCLUSIONS: A clear correspondence between HR rise and adequate Vte/kg during stabilization of very preterm infants was highlighted. RFM might be useful to tailor ventilation, following real-time changes of lung compliance.

AIM: The aim of this study was to assess the resuscitators' opinions of the usefulness and clinical value of using a respiratory function monitor (RFM) when resuscitating extremely preterm infants with positive pressure ventilation. METHODS: The link to an online survey was sent to 106 resuscitators from six countries who were involved in a multicentre trial that compared the percentage of inflations within a predefined target range with and without the RFM. The resuscitators were asked to assess the usefulness and clinical value of the RFM. The survey was online for 4 months after the trial ended in May 2019. RESULTS: The survey was completed by 74 (70%) resuscitators of which 99% considered the RFM to be helpful during neonatal resuscitation and 92% indicated that it influenced their decision-making. The majority (76%) indicated that using the RFM improved their practice and made resuscitation more effective, even when the RFM was not available. Inadequate training was the key issue that limited the effectiveness of the RFM: 45% felt insufficiently trained, and 78% felt more training in using and interpreting the RFM would have been beneficial. CONCLUSION: Resuscitators considered the RFM to be helpful to guide neonatal resuscitation, but sufficient training was required to achieve the maximum benefit.

Objetivo: Definir los rangos de normalidad a través de un gráfico de percentiles para el volumen corriente espirado y la frecuencia respiratoria durante la estabilización postnatal en recién nacidos sanos a término (≥ de 37 semanas de gestación), nacidos por cesárea electiva, respirando espontáneamente, sin dificultad respiratoria y sin necesidad de reanimación, utilizando un monitor de función respiratoria, validado y no invasivo. Diseño del estudio: Se diseñó un estudio observacional prospectivo unicéntrico. El cual se llevó a cabo en el quirófano del servicio de Obstetricia del Hospital Universitario y Politécnico La Fe de Valencia. El muestreo fue no probabilístico de tipo consecutivo. El periodo de reclutamiento comprendió los meses de enero del 2018 a agosto del 2019. Evaluamos a los recién nacidos a término por cesárea después de embarazos sin complicaciones. Inmediatamente después del nacimiento, se aplicó un monitor de función respiratoria con un transductor de flujo proximal adaptado y una máscara facial a los 2, 5 y 10 minutos después del nacimiento durante 90 segundos en cada período, para interferir lo menos posible en la transición fetal neonatal. Analizamos el volumen corriente espirado e inspirado, la frecuencia respiratoria, el porcentaje de fuga y el número de respiraciones grabadas en el registro de cada bebé utilizando un software de análisis de datos para la investigación respiratoria. Resultados: Un total de 243 bebés completaron el estudio. El conjunto de datos final incluyó 59.058 (48,35%) observaciones válidas para cada una de las variables que representan el análisis de 32.801 respiraciones. Con estos datos, construimos un rango de referencia con percentiles 10, 25, 50, 75 y 90 para el volumen corriente espirado y la frecuencia respiratoria. Los volúmenes corrientes se estabilizaron antes en las niñas que en los niños. No se estableció ninguna correlación con el pinzamiento tardío del cordón, la edad gestacional, la morbilidad materna o la indicación de parto por cesárea. Conclusiones: Hemos construido un rango de referencia a través de un gráfico de percentiles para el volumen corriente espirado y la frecuencia respiratoria en los primeros 12 minutos de vida en recién nacidos sanos a término (≥ de 37 SG), nacidos por cesárea electiva con respiración espontánea, sin dificultad respiratoria y sin necesidad de reanimación. Los rangos de referencia pueden ser empleados para la investigación y ser útiles en el entorno clínico tanto para guiar la ventilación con presión positiva, como también el nivel de PEEP/CPAP en recién nacidos con respiración espontánea en la sala de partos. Tras el nacimiento, las curvas de percentiles tanto para el volumen corriente espirado como para la frecuencia respiratoria mostraron una trayectoria ligeramente ascendente alcanzando una meseta a los 5 y 6 minutos de vida respectivamente. Volumen corriente espirado osciló entre 4 a 6 mL/kg durante los primeros minutos de vida, lo que podría indicar que los bebés nacidos por cesárea alcanzan volúmenes corrientes similares a los bebés nacidos por parto vaginal. Sin embargo, encontramos que los bebés nacidos por cesárea requirieron un periodo de tiempo más largo para alcanzar un volumen corriente espirado y frecuencia respiratoria estables. Objective: To retrieve evolving respiratory measures in the first minutes after birth in normal neonates born at term using a respiratory function monitor. Study design: We evaluated newborn babies delivered at term via cesarean after uncomplicated pregnancies. Immediately after birth, a respiratory function monitor with an adapted flowmeter and a face mask were applied at 2, 5, and 10 minutes after birth for 90 seconds in each period. We analyzed expired and inspired tidal volume, respiratory rate (RR), percentage of leakage, and number of analyzed breaths in each individual infant's recording using a respiratory research software. Results: A total of 243 infants completed the study. The final data set included 59 058 (48.35%) valid observations for each of the variables representing the analysis of 32 801 breaths. With these data, we constructed a reference range with 10th, 25th, 50th, 75th, and 90th percentiles for expired tidal volume and RR. Tidal volumes plateaued earlier in female than in male infants. No correlation with delayed cord clamping, gestational age, maternal morbidity, or indication for cesarean delivery were established. Conclusions: We have constructed a reference range with percentiles for inspired and expired tidal volumes and RR in newborn babies born at term for the first 10 minutes after birth. Reference ranges can be employed for research and can be useful in the clinical setting to guide positive pressure ventilation in the delivery room.

Objective To retrieve evolving respiratory measures in the first minutes after birth in normal neonates born at term using a respiratory function monitor. Study design We evaluated newborn babies delivered at term via cesarean after uncomplicated pregnancies. Immediately after birth, a respiratory function monitor with an adapted flowmeter and a face mask were applied at 2, 5, and 10 minutes after birth for 90 seconds in each period. We analyzed expired and inspired tidal volume, respiratory rate (RR), percentage of leakage, and number of analyzed breaths in each individual infant's recording using a respiratory research software. Results A total of 243 infants completed the study. The final data set included 59 058 (48.35%) valid observations for each of the variables representing the analysis of 32 801 breaths. With these data, we constructed a reference range with 10th, 25th, 50th, 75th, and 90th percentiles for expired tidal volume and RR. Tidal volumes plateaued earlier in female than in male infants. No correlation with delayed cord clamping, gestational age, maternal morbidity, or indication for cesarean delivery were established. Conclusions We have constructed a reference range with percentiles for inspired and expired tidal volumes and RR in newborn babies born at term for the first 10 minutes after birth. Reference ranges can be employed for research and can be useful in the clinical setting to guide positive pressure ventilation in the delivery room.

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 Vte 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.

This study aimed to test the accuracy in volume measurements of three available respiratory function monitors (RFMs) for neonatal resuscitation and the effect of changing gas conditions. The Florian, New Life Box Neo-RSD (NLB Neo-RSD) and NICO RFM were tested on accuracy with volumes of 10 and 20 mL and on changes in volume measurements under changing gas conditions (oxygen level 21–100 % and from cold dry air (24 ± 2 °C) to heated humidified air (37 °C). Volume differences >10 % were considered clinically relevant. We found that the mean (SD) volume difference was clinically acceptable for all devices (10, 20 mL): Florian (+8.4 (1.2)%, +8.4 (0.5)%); NLB Neo-RSD (+5.8 (1.1)%, +4.3 (1.4)%); and NICO (−8.2 (0.9)%, −8.7 (0.8)%). Changing from cold dry to heated humidified air increased the volume difference using the Florian (cold dry air, heated humidified air (+5.2 (1.2)%, +12.2 (0.9)%) but not NLB Neo-RSD (+2.0(1.6)%, +3.4(2.8)%) and NICO (−2.3 % (0.8), +0.1 (0.6)%). Similarly, when using heated humidified air, increasing oxygen enlarged increased the volume difference using the Florian (oxygen 21 %, 100 %: +12.2(1.0)%, +19.8(1.1)%), but not NLB Neo-RSD (+0.2(1.9)%, +1.1(2.8)%) and NICO (−5.6(0.9)%, −3.7(0.9)%). Clinically relevant changes occurred when changing both gas conditions (Florian +25.7(1.7)%; NLB Neo-RSD +3.8(2.4)%; NICO −5.7(1.4)%). Conclusion: The available RFMs demonstrated clinically acceptable deviations in volume measurements, except for the Florian when changing gas conditions. What is known: •Respiratory function monitors (RFMs) are increasingly used for volume measurements during respiratory support of infants at birth. •During respiratory support at birth, gas conditions can change quickly, which can influence the volume measurements. What is new: •The available RFMs have clinically acceptable deviations when measuring the accuracy of volume measurements.•The RFM using a hot wire anemometer demonstrated clinically relevant deviations in volume measurements when changing the gas conditions. These deviations have to be taken into account when interpreting the volumes directly at birth.

Neonatal resuscitation is one of the most frequently performed procedures, and it is often successful if the ventilation applied is adequate. Over the last decade, interest in seeking objectivity in evaluating the infant’s condition at birth or the adequacy and effect of the interventions applied has markedly increased. Clinical parameters such as heart rate, color, and chest excursions are difficult to interpret and can be very subjective and subtle. The use of ECG, pulse oximetry, capnography, and respiratory function monitoring can add objectivity to the clinical assessment. These physiological parameters, with or without the combination of video recordings, can not only be used directly to guide care but also be used later for audit and teaching purposes. Further studies are needed to investigate whether this will improve the quality of delivery room management. In this narrative review, we will give an update of the current developments in monitoring neonatal resuscitation.

Einleitung Der Großteil der Neugeborenen im Kreißsaal adaptiert sich unkompliziert nach der Geburt. Eine Atemunterstützung benötigen 10%, eine Reanimation ist bei < 1% aller Geburten notwendig und bleibt damit ein sehr seltenes Ereignis. Dennoch müssen die Ausführenden die Technik und Handhabung der Geräte beherrschen und mit regelmäßigem Training auf den Ernstfall vorbereitet sein. Die Grundlage für das Training bildet die von dem International Liasion Committee on Resuscitation (ILCOR) erstellten Richtlinien. Ziel der vorliegenden Arbeit ist es, den Einfluss verschiedener medizinischer Hilfsmittel auf die geleistete Atemunterstützung während der Reanimation zu untersuchen und Möglichkeiten zur Verbesserung des Trainings der simulierten Neugeborenenreanimation zu evaluieren. Methodik Durchgeführt wurden in vitro Studien zur Neugeborenenreanimation, in denen wir die Handhabung diverser Materialien wie den selbst-entfaltenden Beutel (SIB, mit und ohne Manometer (SIB / SIBM, FA. Ambu) und verschiedene T-Stück- Beatmungsgeräte (TPR1: Perivent, FA. F&P; Healthcare, TPR2: Panda, FA. GE Healthcare), sowie das Reanimationstraining mit Visualisierung der erzeugten Parameter und unter Verwendung eines musikalischen Taktgebers untersuchten. Verwendet wurde ein Simulationspüppchen, welches einem 1000 g Frühgeborenen nachempfunden war. Die Messungen von applizierten Spitzendrücken (PIP) während Standardsimulation und unter konsekutiver Adjustierung der Zieldrücke sowie Tidalvolumen (Vt) und Beatmungsfrequenz (MI) wurden mittels Pneumotachographen, die Thoraxkompressionen (CC) mit einem manuellem Zählgerät aufgezeichnet. Ergebnisse Hinsichtlich Handhabung der verschiedenen manuellen Beatmungsgeräte konnte gezeigt werden, dass der SIB den TPR-Geräten in der zeitlichen Adjustierung des PIP signifikant überlegen ist (PIP von 20 auf 25 cmH2O TPR1 (F&P;) 7,5s; TPR2 (GE) 6,5s; SIB 3,9s, SIBM 3,4s, von 25 auf 40 cmH2O TPR1 18,8s, TPR2 12,7s, SIB 4,4s, SIBM 3,4s). Deutlich konstantere PIP- Werte wurden allerdings mit den TPR appliziert. Durch Training konnte eine statistisch signifikante Reduktion der PIP und Vt-Werte erzielt werden (von 32,3 cm H2O / 6,7 ml auf 17,8 cm H2O / 3,5 ml auf 18,7 cm H2O / 4,1ml). Der musikalische Taktgeber verbesserte die Koordination der kardiopulmonalen Reanimation signifikant hin zu dem empfohlenen 3:1 Verhältnis von Thoraxkompressionen (CC: 115 zu 96/min) und manuellen Inflationen (MI: 38 zu 32 /min). Außerdem wurde die Variabilität zwischen den Anwendern bei den CC um 86% und die der MI um 60% reduziert. Schlussfolgerung In den klinischen Alltag lassen sich aus unseren Studien folgende Erkenntnisse übertragen: Anwender können durch Verwendung des SIBM eine schnellere Anpassung des PIP gewährleisten, wohingegen eine zuverlässigere Applikation desselben und des Vt mit einem TPR gewährleistet wird. Wiederholtes Training und musikalische Taktgeber können dabei helfen dem Anwender mehr Sicherheit in der richtlinienkonformen Reanimation zu geben., Introduction The transition from intrauterine to extrauterine life requires a complex physiological process, nevertheless most neonates manage to go through it on their own. Only 10% need respiratory assistance. Neonatal cardiopulmonary resuscitation (CPR) including chest compressions (CC) is with < 1% a rare event in the delivery room. However medical staff needs to be proficient in neonatal CPR and in handling the different devices. Training, based on international resuscitation guidelines, helps to be skilled for these infrequent events. The aim of this thesis is to assess the effect of different medical devices on manual ventilation during neonatal resuscitation and to evaluate strategys to improve simulated neonatal resuscitation training. Methods We studied practical handling of different devices for manual ventilation and simulated neonatal resuscitation trainung, while visualising generated parameters and using a musical prompt. We used a 1000g preterm neonate manikin to measure positive inspiratory pressures (PIP), tidal volume (Vt) and manual inflations (MI) with a respiratory function monitor (RFM) and CC using a tally counter. Results Regarding handling the different devices for PIP adjustment, there was less time needed when using SIB (PIP from 20 to 25 cmH2O TPR1 (F&P;) 7.5s; TPR2 (GE) 6.5s; SIB 3.9s, SIBM(SIB with manometer) 3.4s, from 25 to 40 cmH2O TPR1 18.8s, TPR2 12.7s, SIB 4.4s, SIBM 3.4s). When using TPR staff could stay closer to target PIPs. With regard to training PIP and Vt-values could significantly be reduced (from 32.3 cm H2O / 6.7 ml to 17.8 cm H2O / 3.5 ml to 18.7 cm H2O / 4.1ml). 3:1 Coordination of CC (115 to 96/min) and MI (38 to 32/min) during CPR was significantly better with use of a musical prompt. Apart from that interindividual variability could be reduced about 86% regarding CC and 60% regarding MI. Take home points For every day use: Staff can adjust PIP faster with SIBM (SIB+maonometer) PIP were closer to target values using TPR. Routine training and a musical prompt can help to feel more confident performing neonatal CPR.