The first breath during resuscitation of prematurely born infants

Abstract

BackgroundThe first five initial inflation pressures and times during resuscitation of prematurely born infants are frequently lower than those recommended and rarely result in tidal volumes exceeding the anatomical dead space. Greater volumes were produced when the infant was provoked to inspire by an inflation (active inflation). AimsTo assess factors associated with a shorter time to the first active inflation. Study designRespiratory function monitoring was undertaken during resuscitation, peak inflation pressures (PIP), inflation times and the infant's respiratory activity were simultaneously recorded. SubjectsInfants with a gestational age<34weeks requiring resuscitation at birth. Outcome measuresThe relationships of the PIP and inflation time of the first five inflations and first active inflation to the time to the first active inflation. ResultsRecordings from 47 infants, median gestational age of 29 (23–34) weeks, were analysed. The median PIP of the first five inflations was 27 (range 9–37) cmH2O and inflation time 1.22 (range 0.32–4.08) s. The median PIP of the first active inflation was 25 (range 19–37) cmH2O and inflation time 1.35 (0.35–3.67) s. The median time to the first active inflation was 7 (range 0–50) seconds and was inversely correlated with the PIP (p=0.001) and inflation time (p=0.018) of the first five inflations and the PIP (p=0.001) and inflation time (p=0.008) of the first active inflation. ConclusionThe magnitude of the inflation pressures and times of the first five inflations inversely correlate with the time to the first breath during resuscitation.