The first breath during resuscitation of prematurely born infants

Abstract

Background: Studies have shown that inflation pressures and times used during the initial resuscitation of prematurely born infants are frequently lower than those recommended, rarely resulting in tidal volumes exceeding the anatomical dead space. Greater volumes were produced when the infant was first provoked to inspire during an inflation (active inflation).

Aims and objectives: To assess factors associated with a shorter time to the first active inspiration.

Methods: Infants with a gestational age<34 weeks requiring resuscitation at birth were assessed. Peak inflation pressures (PIP, inflation pressure plus PEEP), inflation times and the infant's respiratory efforts were simultaneously recorded using a respiratory function monitor. The PIP and inflation time of the first five inflations and the first active inflation and the time to the first active inflation were determined.

Results: Recordings from 47 infants, median gestational age of 29 (23-34) weeks, were analysed. The median PIP of the first five inflations was 25 (range 19 – 37) cmH₂O and inflation time was 1.22 (0.32 -4.08 ) seconds. The median PIP of the first active inflation was 25 (range 19-37) cmH2O and the inflation time was 1.35 (0.35-3.67) seconds. 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.

Conclusion: Use of the recommended initial inflation pressures and times rather than lower pressures and times may improve the efficacy of resuscitation by reducing the time to the first breath during resuscitation.