Delivery room respiratory management of the term and preterm infant

Comparison of Efficacy of Pressure Controlled vs. Traditional Manual Mask Ventilation for Newborn Resuscitation - A Simulation-Based Pilot Randomized Control Trial

OBJECTIVES

To determine efficacy of non-invasive positive pressure face mask ventilation using a ventilator device (NIPPmV) for achieving early effective ventilation compared to that by self-inflating bag (SIB) or T- piece resuscitator (TPR).

METHODS

The authors video recorded 33 trained resuscitators using NIPPmV (provided using ventilator device), SIB [a 500 ml silicone SIB without a positive end expiratory pressure (PEEP) valve] and a TPR. Using a continuous pressure recording system and a neonatal manikin, the authors evaluated the efficacy of the ventilation to achieve early effective ventilation during 30 s of ventilation. The primary outcome was time to achieve effective chest rise. Secondary outcomes were peak inspiratory pressure (PIP), ventilation rate and the need to perform ventilation corrective steps during positive pressure ventilation (PPV) among the devices.

RESULTS

Total 99 videos were recorded. The time(s) taken to achieve the first chest rise was significantly lesser in NIPPmV group compared to SIB and TPR (3.0 ± 1.7 vs. 3.7 ± 1.9 vs. 7.5 ± 5.4, respectively, p <0.001). The mean PIP delivered by NIPPmV compared to SIB & TPR (19.8 ± 1.6 vs. 35.6 ± 7.4 vs. 17.8 ± 2.0 cm H20 respectively; p <0.001) was more accurate with preset PIP. Ventilation, in terms of breath rate, was observed to be controlled more accurately with NIPPmV compared to SIB & TPR (50 vs. 42 vs. 33 per min respectively; p <0.001).

CONCLUSIONS

The non-invasive positive pressure face mask ventilation using a ventilator (NIPPmV) resulted in achieving early, effective and consistent ventilation.

Prophylactic surfactant nebulisation for the early aeration of the preterm lung: a randomised clinical trial

OBJECTIVE

The effect of prophylactic surfactant nebulisation (SN) is unclear. We aimed to determine whether prophylactic SN improves early lung aeration.

DESIGN

Parallel, randomised clinical trial, conducted between March 2021 and January 2022.

SETTING

Delivery room (DR) of a tertiary neonatal centre in Zurich, Switzerland.

PATIENTS

Preterm infants between 26 ^0/7 and 31 ^6/7 weeks gestation INTERVENTIONS: Infants were randomised to receive positive distending pressure alone or positive distending pressure and additional SN (200 mg/kg; poractant alfa) using a customised vibrating membrane nebuliser. SN commenced with the first application of a face mask immediately after birth.

MAIN OUTCOME MEASURES

Primary outcome was the difference in end-expiratory lung impedance from birth to 30 min after birth (∆EELI_30min). EELI correlates well with functional residual capacity. Secondary outcomes included physiological and clinical outcomes.

RESULTS

Data from 35 infants were collected, and primary outcome data were analysed from 32 infants (n=16/group). Primary outcome was not different between intervention and control group (median (IQR): 25 (7-62) vs 10 (0-26) AU/kg, p=0.21). ∆EELI was slightly higher in the intervention group at 6 and 12 hours after birth, particularly in the central areas of the lung. There were no differences in cardiorespiratory and clinical parameters. Two adverse events were noted in the intervention group.

CONCLUSIONS

Prophylactic SN in the DR did not significantly affect ∆EELI_30min and showed only minimal effects on lung physiology. Prophylactic SN in the DR was feasible. There were no differences in clinical outcomes.

TRIAL REGISTRATION NUMBER

NCT04315636.

Golden hour of neonatal life: Need of the hour

"Golden Hour" of neonatal life is defined as the first hour of post-natal life in both preterm and term neonates. This concept in neonatology has been adopted from adult trauma where the initial first hour of trauma management is considered as golden hour. The "Golden hour" concept includes practicing all the evidence based intervention for term and preterm neonates, in the initial sixty minutes of postnatal life for better long-term outcome. Although the current evidence supports the concept of golden hour in preterm and still there is no evidence seeking the benefit of golden hour approach in term neonates, but neonatologist around the globe feel the importance of golden hour concept equally in both preterm and term neonates. Initial first hour of neonatal life includes neonatal resuscitation, post-resuscitation care, transportation of sick newborn to neonatal intensive care unit, respiratory and cardiovascular support and initial course in nursery. The studies that evaluated the concept of golden hour in preterm neonates showed marked reduction in hypothermia, hypoglycemia, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). In this review article, we will discuss various components of neonatal care that are included in "Golden hour" of preterm and term neonatal care.

Golden 60 minutes of newborn's life: Part 2: Term neonate

The concept of "Golden 60 minutes" or "Golden Hour" has been derived from adult trauma. It has been defined as the first 60 min of postnatal life. It has been seen that care received by any newborn in the initial first hour has implications in the future life, showing the importance of golden hour. The major cause of neonatal mortality term newborn is asphyxia, which can be reduced with effective resuscitation. In golden hour approach for term newborn, the importance is given to effective and evidence based resuscitation, post-resuscitation care, delayed cord clamping, prevention of hypothermia, immediate breast feeding, prevention of hypoglycemia, and starting of therapeutic hypothermia in case of moderate to severe asphyxia. In this part of review, we will cover all the golden hour interventions in term neonate with current evidence.