Elsevier

The Journal of Pediatrics

Volume 160, Issue 3, March 2012, Pages 377-381.e2
The Journal of Pediatrics

Original Article
Respiratory Function Monitor Guidance of Mask Ventilation in the Delivery Room: A Feasibility Study

https://doi.org/10.1016/j.jpeds.2011.09.017Get rights and content

Objective

To investigate whether using a respiratory function monitor (RFM) during mask resuscitation of preterm infants reduces face mask leak and improves tidal volume (VT).

Study design

Infants receiving mask resuscitation were randomized to have the display of an RFM (airway pressure, flow, and VT waves) either visible or masked.

Result

Twenty-six infants had the RFM visible, and 23 had the RFM masked. The median mask leak was 37% (IQR, 21%-54%) in the visible RFM group and 54% (IQR, 37%-82%) in the masked RFM group (P = .01). Mask repositioning was done in 19 infants (73%) of the visible group and in 6 infants (26%) of the masked group (P = .001). The median expired VT was similar in the 2 groups. Oxygen was provided to 61% of the visible RFM group and 87% of the RFM masked group (P = .044). Continuous positive airway pressure use was greater in the visible RFM group (73% vs 43%; P = .035). Intubation in the delivery room was done in 21% of the visible group and in 57% of the masked group (P = .035).

Conclusion

Using an RFM was associated with significantly less mask leak, more mask adjustments, and a lower rate of excessive VT.

Section snippets

Methods

All infants were born at The Royal Women’s Hospital, Melbourne, Australia, a tertiary perinatal center where ∼6000 infants are delivered and more than 100 infants with birth weight <1000 g are admitted to the NICU annually. The trial was conducted between November 2008 and January 2010. Infants who were <32 weeks postmenstrual age and deemed to have inadequate breathing after birth were eligible. Exclusion criteria included undocumented gestational age and a congenital abnormality that could

Results

A total of 262 eligible infants born during the study period (Figure 1; available at www.jpeds.com). Of these, 100 were randomized, 54 to the RFM visible group and 46 to the RFM masked group. Only 26 infants in the RFM visible group and 23 infants in the RFM masked group received PPV and had respiratory function data available for analysis. The median (IQR) resuscitation experience of the primary resuscitator was similar in both groups, 15 months (5-36 months) in the RFM visible group and 11

Discussion

Although PPV is commonly used in the DR, very little objective data are available to assess its effectiveness.6 This contrasts with practice in NICUs, where ventilation is usually guided by the continuous display of airway pressure, gas flow, VTe and endotracheal tube leak data.31, 32, 33, 34 Others have noted the importance of the first “golden hour” and the usefulness of extending monitoring techniques used in the NICU to the DR.22, 23, 24

This study compared PPV guided by a display of

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      Citation Excerpt :

      For the important outcome of face mask leak, the three RCTs could not be meta-analyzed as the measurement of leak was reported differently in each study. One trial reported median (IQR) mask leak per infant for the first 40 inflations and found a lower median leak when respiratory function monitoring was displayed (p = 0.01).30 Another trial reported percentage of leak > 75 % in the first 10 minutes and found less leak when respiratory function monitoring was displayed (p = 0.001).31

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    G.S., C.K., and J.D. are past recipients of a Royal Women’s Hospital Postgraduate Scholarship. G.S. is supported in part by a Monash University International Postgraduate Research Scholarship. P.D. and S.H. are supported by Australian National Health and Medical Research Council Practitioner and Principal Research Fellowships, respectively. P.D., S.H., and C.M. hold an Australian National Health and Medical Research Council Program Grant (384100). Fisher & Paykel Healthcare (Auckland, New Zealand) provided the T-piece circuits for the study. Neither the study sponsors nor any company that manufactures, markets, or sells any equipment used in the study were involved in study design, data collection or interpretation, or the decision to present or publish the results. The authors declare no conflicts of interest.

    Registered with the Australian and New Zealand Clinical Trials Registry: ACTRN12608000357358.

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