Reply to Letter: “Laryngeal Mask Airway and newborn resuscitation” [Vincenzo Zanardo

Abstract

We thank you and Dr. Zanardo very much for his comments. Currently, the laryngeal mask airway (LMA) is widely used in adult anaesthesia and cardiopulmonary resuscitation. It has been shown to be effective in neonatal resuscitation.1Zanardo V. Simbi A.K. Savio V. Micaglio M. Trevisanuto D. Neonatal resuscitation by laryngeal mask airway after elective cesarean section.Fetal Diagn Ther. 2004; 19: 228-231Crossref PubMed Scopus (22) Google Scholar, 2Trevisanuto D. Micaglio M. Pitton M. Magarotto M. Piva D. Zanardo V. Laryngeal mask airway: is the management of neonates requiring positive pressure ventilation at birth changing?.Resuscitation. 2004; 62: 151-157Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar Recently, international guidelines for neonatal resuscitation have recommended its use when bag-mask ventilation (BMV) is ineffective and/or endotracheal intubation (ETI) is unsuccessful.3American Heart Association, American Academy of Pediatrics 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: neonatal resuscitation guidelines.Pediatrics. 2006; 117: e1029-e1038Crossref PubMed Scopus (195) Google Scholar, 4Kattwinkel J. Perlman J.M. Aziz K. et al.Part 15: neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Circulation. 2010; 122: S909-S919Crossref PubMed Scopus (406) Google Scholar Dr. Zanardo has done a lot of work on the application of LMA in neonatal resuscitation. At the beginning of our research, his studies1Zanardo V. Simbi A.K. Savio V. Micaglio M. Trevisanuto D. Neonatal resuscitation by laryngeal mask airway after elective cesarean section.Fetal Diagn Ther. 2004; 19: 228-231Crossref PubMed Scopus (22) Google Scholar, 2Trevisanuto D. Micaglio M. Pitton M. Magarotto M. Piva D. Zanardo V. Laryngeal mask airway: is the management of neonates requiring positive pressure ventilation at birth changing?.Resuscitation. 2004; 62: 151-157Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar helped us a great deal. In fact, our study concluded with the advantages of LMA exclusively over BMV and recommended that it might be routinely used. Dr. Zanardo might misunderstand our opinion a little. However, there was a lack of detailed reports regarding the skill of LMA-insertion techniques in newborns. Although we had received training about LMA before this study, we did not have a great deal of experience in its use. In the initial phase, we did encounter vomiting and regurgitation as have been reported in adult studies, but the situation was soon improved when we noticed the problem and summarised some skill points, which have been reported in our article.5Zhu X.Y. Lin B.C. Zhang Q.S. Ye H.M. Yu R.J. A prospective evaluation of the efficacy of the Laryngeal Mask Airway during neonatal resuscitation.Resuscitation. 2011; 82: 1405-1409Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar In the study, we compared the incidence of regurgitation between the LMA group and the BMV group. The gestational ages and birth weights of the two groups have been mentioned in the result of baseline characteristics. There were no significant differences between the two groups in the gestational age and birth weight. The aim of our study was to explore the efficacy and safety of using LMA in neonatal resuscitation by comparing the effect of LMA with BMV. Is it necessary to add a control group of infants who were treated with neither LMA nor BMV? We agree that our study was limited because we did not provide a detailed description of where the resuscitated infants were transferred from the delivery room. In fact, in the LMA group, there were 100 (100/205, 48.78%) infants transferred to the neonatal intensive care unit (NICU), while 92 (92/164, 56.10%) infants were transferred to NICU in the BMV group. However, what we studied in this article were the application and feasibility of LMA in neonatal resuscitation, rather than the effect of LMA on breast-feeding rate. We thank Dr. Zanardo for his help and comments again. We would improve the aspects that he has mentioned in our further study. All authors have no conflicts of interest.