Abstract
Introduction: With the advent of technological advancement and better scientific understanding it is possible now to successfully resuscitate and save babies born at less than 500 grams. Stabilization of these infants in the delivery room (DR) is one of the goals of the golden hour management. While some factors, including temperature management and airway care have standards, there is paucity of data on the optimal peak inspiratory pressure (PIP). The Neonatal Resuscitation Program (NRP) recommends using the same inflation pressure of 20 cm to 25 cm H2O for preterm infants as used for term infants. Preterm lungs are not the same as term infants. Due to the smaller lung volume, capacities and dynamic pulmonary mechanics, these preterm infants are prone to pulmonary complications including pneumothorax. Therefore, there is need to use PIP judiciously in the DR. Methods and Results: In this brief report we present two cases of newborn infants that were born at less than 500 grams and were successfully resuscitated with a lower PIP. The success criteria in the DR were heart rate greater than 100 per minute and adequate oxygen saturations minute by minute per NRP guidelines with minimal use of supplemental oxygen. Conclusion: While we need good prospectively designed studies to document the ideal PIP for these extreme preterm infants, we suggest a PIP lower than the currently recommended may be sufficient for some extremely preterm infants.
Highlights
With the advent of technological advancement and better scientific understanding it is possible to successfully resuscitate and save babies born at less than 500 grams
In this report we present two cases of newborn infants that were born at less than 500 grams and were successfully resuscitated with a lower peak inspiratory pressure (PIP) (18 cm H2O)
At the time of this report both infants are stable in the NICU
Summary
With the advent of technological advancement and better scientific understanding it is possible to successfully resuscitate and save babies born at less than 500 grams. The neonatal viability and intervention are a matter of continuous debate Should it be gestational age based or weight based? The American Academy of Pediatrics (AAP) recommends comfort care rather than active resuscitation for infants born at less than 22 weeks gestation. Neonatal intensive care units (NICU) with the capacity to resuscitate are required to provide support to all live birth irrespective of gestational age or birth weight. The Neonatal Resuscitation Program (NRP) has introduced a chapter in the textbook for the care for premature infants, when it comes to the use of positive pressure ventilation it does not provide specific recommendations for this group of extreme premature infants. In this report we present two cases of newborn infants that were born at less than 500 grams and were successfully resuscitated with a lower PIP (18 cm H2O). At the time of this report both infants are stable in the NICU (only the delivery room course is presented here, the details of the NICU course is not presented for the value of space and time)
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