Resuscitation in Preterm Infants; Extended Documentation of Procedures

Paper in proceeding, 2013

Background: A lung protective strategy of ventilation is recommended during resuscitation in newborn infants limiting tidal volume to less than 8 ml/kg to reduce the risk of lung overdistention, volutrauma. As the mechanical properties of the respiratory system change rapidly after birth monitoring of respiratory function is recommended also during the first minutes of life to avoid lung injury (J Pediatr 2008;153:741) Objective: To follow respiratory function parameters, such as tidal volume (Vt), respiratory system compliance (Crs) and resistance (Rrs) during resuscitation in preterm infants. Derived data together with the clinical signs are used to describe and document the course of the resuscitation . Design/Methods: A pneumotachometer with a pressure port was attached to the face mask (Neopuff® or Laerdal®) or to the ET-tube (for intubated patients). Flow and pressure were measured and used to derive respiratory system mechanics (Crs and Rrs) together with corresponding positive inspiratory pressure (PIP) and Vt. Ten infants [median (range) birth weight 0.84 (0.47-1.3) kg; GA 25.5 (25-29) weeks] with apnoea and bradycardia (heart rate (HR)<100 /min) at birth were studied during the first 5 min of life during resuscitation. Conclusions: This observational study showed considerable variations in respiratory system mechanics during resuscitation. High PIP was sometimes required to overcome the elastic and resistive forces of the respiratory system. Crs was low and Rrs high compared to healthy preterm infants (Crs/kg ~1 ml/cmH2O; Rrs~90-100 cmH2O/L/s; Am J Crit Care Med 2002; 165:83). With changing and improving respiratory mechanics the risk for lung overdistension and volutrauma increases. Our result favor an extended documentation of the resuscitation procedures for follow up, training and educational purposes.