Abstract
AimTo evaluate the direct effect of repetitive tactile stimulation on breathing effort of preterm infants at birth. MethodsThis randomized controlled trial compared the effect of repetitive stimulation on respiratory effort during the first 4 min after birth with standard stimulation based on clinical indication in preterm infants with a gestational age of 27–32 weeks. All details of the stimulation performed were noted. The main study parameter measured was respiratory minute volume, other study parameters assessed measures of respiratory effort; tidal volumes, rate of rise to maximum tidal volumes, percentage of recruitment breaths, and oxygenation of the infant. ResultsThere was no significant difference in respiratory minute volume in the repetitive stimulation group when compared to the standard group. Oxygen saturation was significantly higher (87.6 ± 3.3% vs 81.7 ± 8.7%, p = .01) while the amount of FiO2 given during transport to the NICU was lower (28.2 (22.8–35.0)% vs 33.6 (29.4–44.1)%, p = .04). There was no significant difference in administration of positive pressure ventilation (52% vs 78%, p = .13), or the duration of ventilation (median (IQR) time 8 (0–118)s vs 35 (13–131)s, p = .23). Caregivers decided less often to administer caffeine in the delivery room to stimulate breathing in the repetitive stimulation group (10% vs 39%, p = .036). ConclusionAlthough the increase in respiratory effort during repetitive stimulation did not reach significance, oxygenation significantly improved with a lower level of FiO2 at transport to the NICU. Repetitive tactile stimulation could be of added value to improve breathing effort at birth.
Highlights
Most preterm infants need respiratory support for lung aeration during transition at birth [1,2,3]
We demonstrated in a recent observational study [13] that only 67% of preterm infants were stimulated and an effect could be observed in 18% of stimulation episodes
We aimed to evaluate the direct effect of a standardized repetitive tactile stimulation on breathing effort of preterm infants at birth compared to standard stimulation based on clinical indication
Summary
Most preterm infants need respiratory support for lung aeration during transition at birth [1,2,3]. There is still a high failure rate of Continuous Positive Airway Pressure (CPAP) in preterm infants after birth [4], which requires the infant to breath effectively. Studies have shown that most preterm infants breathe at birth [3], even during and in between Positive Pressure Ventilation (PPV) [1,2], but in the majority of infants their respiratory drive is weak and insufficient to aerate their lungs. Thereby, it has been shown that preterm infants in whom mechanical ventilation is avoided after birth have better lung mechanics and decreased work of breathing at 8 weeks post-term [8]
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