Abstract
BackgroundIf infants fail to initiate spontaneous breathing, resuscitation guidelines recommend respiratory support with positive pressure ventilation (PPV). The purpose of PPV is to establish functional residual capacity and deliver an adequate tidal volume (VT) to achieve gas exchange.ObjectiveThe aim of our pilot study was to measure changes in exhaled carbon dioxide (ECO2), VT, and rate of carbon dioxide elimination (VCO2) to assess lung aeration in preterm infants requiring respiratory support immediately after birth.MethodA prospective observational study was performed between March and July 2013. Infants born at <37 weeks gestational age who received continuous positive airway pressure (CPAP) or PPV immediately after birth had VT delivery and ECO2 continuously recorded using a sensor attached to the facemask.ResultsFifty-one preterm infants (mean (SD) gestational age 29 (3) weeks and birth weight 1425 (592 g)) receiving respiratory support in the delivery room were included. Infants in the CPAP group (n = 31) had higher ECO2 values during the first 10 min after birth compared to infants receiving PPV (n = 20) (ranging between 18–30 vs. 13–18 mmHg, p<0.05, respectively). At 10 min no significant difference in ECO2 values was observed. VT was lower in the CPAP group compared to the PPV group over the first 10 min ranging between 5.2–6.6 vs. and 7.2–11.3 mL/kg (p<0.05), respectively.ConclusionsImmediately after birth, spontaneously breathing preterm infants supported via CPAP achieved better lung aeration compared to infants requiring PPV. PPV guided by VT and ECO2 potentially optimize lung aeration without excessive VT administered.
Highlights
In utero the airways are liquid-filled and the lungs take no part in gas exchange, which occurs across the placenta [1]
Infants in the continuous positive airway pressure (CPAP) group (n = 31) had higher exhaled CO2 (ECO2) values during the first 10 min after birth compared to infants receiving positive pressure ventilation (PPV) (n = 20)
VT was lower in the CPAP group compared to the PPV group over the first 10 min ranging between 5.2–6.6 vs. and 7.2–11.3 mL/kg (p,0.05), respectively
Summary
In utero the airways are liquid-filled and the lungs take no part in gas exchange, which occurs across the placenta [1]. Most preterm infants breathe spontaneously at birth [3], many require continuous positive airway pressure (CPAP) to support lung aeration [4]. If infants fail to initiate spontaneous breathing, neonatal resuscitation guidelines recommend positive pressure ventilation (PPV) [5]. There is no information available regarding the changes in lung aeration after birth in preterm infants who are given CPAP or PPV as respiratory support at birth. If infants fail to initiate spontaneous breathing, resuscitation guidelines recommend respiratory support with positive pressure ventilation (PPV). The purpose of PPV is to establish functional residual capacity and deliver an adequate tidal volume (VT) to achieve gas exchange
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