Elsevier

Clinics in Perinatology

Volume 39, Issue 4, December 2012, Pages 857-869
Clinics in Perinatology

Resuscitation of Preterm Infants: Delivery Room Interventions and Their Effect on Outcomes

https://doi.org/10.1016/j.clp.2012.09.010Get rights and content

Section snippets

Key Points

  • Mask leak and airway obstruction are common during mask ventilation.

  • Airway pressure is a poor proxy for delivered tidal volume; therefore, tidal volume delivery should be monitored.

  • CPAP/PEEP should be started in extremely preterm infants in the delivery room before intubation and surfactant is considered.

  • Establishment of lung inflation in apneic newborns can be achieved with either shorter or longer inflation times.

Respiratory support in the DR

The International Liaison Committee on Resuscitation and various national resuscitation guidelines recommend equipment and techniques for neonatal resuscitation.23, 24, 25 They all agree that PPV is the cornerstone of respiratory support immediately after birth.23, 24, 25 The purpose of PPV is to create an FRC, deliver an adequate VT to facilitate gas exchange and stimulate breathing, while minimizing lung injury.1 To establish FRC immediately after birth and to prevent lung collapse PEEP or

Monitoring of body temperature during neonatal stabilization

It was traditionally recommended that, to prevent them from becoming cold, all infants should be placed under radiant heat, dried with towels, and covered with warmed towels and a hat after birth.70 Despite these measures, hypothermia on admission to the NICU remained common and was associated with increased mortality among extremely preterm infants.71 Although it is not clear whether this association is coincidental (sick babies who are more likely to die spend longer being resuscitated in the

Summary

Despite advances in neonatal care, the rate of oxygen dependence at 36 weeks' postmenstrual age or BPD has not fallen. A lung-protective strategy should start immediately after birth to establish a FRC, reduce volutrauma and atelectotrauma, facilitate gas exchange, and improve oxygenation during neonatal transition.

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    Conflict of interest: None.

    GMS is supported in part by a Banting Postdoctoral Fellowship, Canadian Institute of Health Research, and an Alberta Innovates-Health Solution Clinical Fellowship.

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