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Impact of delivered tidal volume on the occurrence of intraventricular haemorrhage in preterm infants during positive pressure ventilation in the delivery room
  1. Qaasim Mian1,2,
  2. Po-Yin Cheung1,2,
  3. Megan O’Reilly1,2,
  4. Samantha K Barton3,
  5. Graeme R Polglase3,
  6. Georg M Schmölzer1,2
  1. 1Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada
  2. 2Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
  3. 3The Ritchie Centre, Hudson Institute of Medical Research, and Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
  1. Correspondence to Dr Georg M Schmölzer, Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta T5H 3V9, Canada; georg.schmoelzer{at}me.com

Abstract

Background and objectives Delivery of inadvertent high tidal volume (VT) during positive pressure ventilation (PPV) in the delivery room is common. High VT delivery during PPV has been associated with haemodynamic brain injury in animal models. We examined if VT delivery during PPV at birth is associated with brain injury in preterm infants <29 weeks’ gestation.

Methods A flow-sensor was placed between the mask and the ventilation device. VT values were compared with recently described reference ranges for VT in spontaneously breathing preterm infants at birth. Infants were divided into two groups: VT<6  mL/kg or VT>6 mL/kg (normal and high VT, respectively). Brain injury (eg, intraventricular haemorrhage (IVH)) was assessed using routine ultrasound imaging within the first days after birth.

Results A total of 165 preterm infants were included, 124 (75%) had high VT and 41 (25%) normal VT. The mean (SD) gestational age and birth weight in high and normal VT group was similar, 26 (2) and 26 (1) weeks, 858 (251) g and 915 (250) g, respectively. IVH in the high VT group was diagnosed in 63 (51%) infants compared with 5 (13%) infants in the normal VT group (P=0.008).

Severe IVH (grade III or IV) developed in 33/124 (27%) infants in the high VT group and 2/41 (6%) in the normal VT group (P=0.01).

Conclusions High VT delivery during mask PPV at birth was associated with brain injury. Strategies to limit VT delivery during mask PPV should be used to prevent high VT delivery.

  • infants
  • newborn
  • delivery room
  • neonatal resuscitation
  • brain injury
  • respiratory functions tests

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Footnotes

  • Contributors QM was involved in data collection, analysis and interpretation. He also wrote the first draft and performed revisions of the drafted article and approved the final version of the manuscript for submission. P-YC, MO and GMS were involved in the conception and design of the study. They were also involved in data collection, analysis and interpretation and performed critical revisions of the drafted article and approved the final version of the manuscript for submission. GRP and SKB were involved in the conception and design of the study. They were also involved in data analysis and interpretation and performed critical revisions of the drafted article and approved the final version of the manuscript for submission.

  • Funding QM was supported by a Summer Studentship of Women’s and Children Research Institute. GRP is supported by a NH&MRC and National Heart Foundation Career Development Fellowship (1105526). SKB is supported by an ARC/NMRC fellowship (1110040). GMS is a recipient of the Heart and Stroke Foundation/University of Alberta Professorship of Neonatal Resuscitation and a Heart and Stroke Foundation Canada and a Heart and Stroke Foundation Alberta New Investigator Award. This research has been facilitated by the Women and Children’s Health Research Institute through the generous support of the Stollery Children’s Hospital Foundation.

  • Disclaimer The authors have no financial relationships relevant to this article to disclose. No current funding source for this study. The funder had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

  • Competing interests None declared.

  • Ethics approval The Neonatal Research Committee, Northern Alberta Neonatal Program and Health Research Ethics Board, University of Alberta approved the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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