Search

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. [ABSTRACT FROM AUTHOR]

A noninvasive approach in the delivery room in place of intubation and mechanical ventilation can reduce rates of bronchopulmonary dysplasia and death. Nevertheless, the rate of nasal continuous positive airway pressure failure still remains high. In order to prevent lung injury and to enhance the success of continuous positive airway pressure, sustained inflation (administration by face mask or nasopharyngeal tube of a high peak pressure of 20-25 cm H2O, maintained for 10-15 s) has been recently proposed to establish an early and efficient functional residual capacity in the delivery room. Sustained inflation is an intriguing therapy, although the results of clinical trials are controversial in terms of respiratory outcomes. A critical role in the success of sustained inflation could be the presence of open or closed glottis and the contribution of spontaneous breathing that allows air to enter the lungs during the maneuver. Recent neonatal resuscitation guidelines suggest that sustained inflation may be considered in individual clinical circumstances or research settings. Respiratory distress syndrome (RDS) is the most common respiratory pathology in preterm infants and bronchopulmonary dysplasia (BPD) remains an important sequela in these patients. In the past, conventional mechanical ventilation or high-frequency oscillatory ventilation plus surfactant replacement therapy have been considered the standard approach for management of RDS. However, we know that lung injury is directly related to duration of mechanical ventilation and therefore noninvasive approaches [e.g. nasal continuous positive airway pressure (CPAP)] often associated with surfactant administration have been demonstrated to be a valid alternative [1]. Two recent meta-analyses suggest that a noninvasive approach from the delivery room instead of intubation and mechanical ventilation can reduce rates of BPD and death with a number needed to treat of 35 and 25, respectively, in very preterm infants [2, 3]. Nevertheless, the rate of CPAP failure remains high. In fact, recent randomized controlled trials (RCTs) reported that more than 50% of very low birth weight infants initially assisted in the delivery room with nasal CPAP required mechanical ventilation in the neonatal intensive care unit [4-6]. [ABSTRACT FROM AUTHOR]