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Mask leak and airway obstruction are common during mask ventilation.
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Airway pressure is a poor proxy for delivered tidal volume; therefore, tidal volume delivery should be monitored.
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CPAP/PEEP should be started in extremely preterm infants in the delivery room before intubation and surfactant is considered.
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Establishment of lung inflation in apneic newborns can be achieved with either shorter or longer inflation times.
Resuscitation of Preterm Infants: Delivery Room Interventions and Their Effect on Outcomes
Section snippets
Key Points
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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Cited by (13)
Duration of mechanical ventilation and neurodevelopment in preterm infants
2019, Archives of Disease in Childhood: Fetal and Neonatal EditionNew Strategies of Pulmonary Protection of Preterm Infants in the Delivery Room with the Respiratory Function Monitoring
2019, American Journal of PerinatologyRelationship of resuscitation, respiratory function monitoring data and outcomes in preterm infants
2018, European Journal of Pediatrics
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.