Ventilation of Very Preterm Infants in the Delivery Room

Arjan   B.   te Pas; Frans   J.   Walther

Abstract

Adequate functional residual capacity (FRC) is difficult to create with manual ventilation in very preterm infants and carries a high risk for creating lung damage. International guidelines for neonatal resuscitation do not provide ventilation guidelines for very preterm infants despite evidence that a different approach may be warranted. Peak inspiratory pressures (PIPs) generated with bag and mask ventilation are usually insufficient to open up the lung or unintentionally excessive. The long time constant of the fluid-filled immature lung can be overcome by delivering a prolonged inflation at a lower PIP, followed by application of positive end-expiratory pressure (PEEP) to maintain FRC after lung recruitment. To minimize the damage provoked by manual ventilation a consistent PIP, adequate PEEP and prolonged inflation have to be guaranteed. A mechanical pressure-limited T-piece resuscitator is the only device that meets these requirements. Leakage between mask and face is prevented by using the nasopharyngeal route. After resuscitation, FRC can be preserved by starting nasal continuous positive airway pressure (nCPAP) in the delivery room, which will reduce the need for intubation and mechanical ventilation. This review discusses the accumulated data supporting these recommendations.

Keywords: Resuscitation, preterm infants, ventilation, Neopuff® infant resuscitator, continuous positive airway pressure, bronchopulmonary dysplasia