Original ArticleSpontaneously Breathing Preterm Infants Change in Tidal Volume to Improve Lung Aeration Immediately after Birth
Section snippets
Methods
This study was carried out at The Royal Alexandra Hospital, Edmonton, Canada, a tertiary perinatal center admitting ∼350 infants with a birth weight of <1500 g annually to the neonatal nursery. The Royal Alexandra Hospital Research Committee and Health Ethics Research Board, University of Alberta, and the Health Ethics Research Board approved the study and granted deferred consent. After admission to the neonatal intensive care unit, parental consent was requested. Between June 2013 and July
Results
The clinical team attended a total of 436 deliveries, and the research team attended 297 deliveries. Twenty-five infants were excluded because parents did not consent to use the recorded data. A total of 242 infants were excluded because 47 did not require any respiratory support, 12 received only free-flow oxygen, and 183 received PPV at any given time leaving 30 infants eligible for this study (Table). A total of 3200 breaths were analyzed (1688 [53%] were excluded with mask leak >30%),
Discussion
In utero, the airways are liquid-filled and the lungs do not take part in gas exchange, which occurs across the placenta. At birth, lung liquid has to be cleared from the airways to allow air entry to generate FRC and facilitate gas exchange.6 To achieve lung aeration term and preterm infants use various breathing patterns within the first minutes after birth,15, 16 and the majority of preterm infants cry and breathe spontaneously after birth.1 For this study, we analyzed the first 100 breaths
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2022, Resuscitation PlusRepetitive versus standard tactile stimulation of preterm infants at birth – A randomized controlled trial
2018, ResuscitationCitation Excerpt :Short-term clinical outcomes were noted: intraventricular haemorrhage, intubation during resuscitation or within the first 24 h after birth and need for surfactant. Mian et al. measured an average MV of 150 ± 70 ml/kg/min over the first 100 breaths in preterm infants <33 weeks GA [21]. The study of Huberts et al. shows that MV in spontaneous breathing preterm infants increases with 60% from minute 2 to minute 5, but this increase was lower in infants receiving PPV [18].
The Breathing Effort of Very Preterm Infants at Birth
2018, Journal of PediatricsCitation Excerpt :Similarly, Mian et al reported MV similar to ours in the first 2 minutes and at 5 minutes,10 but they included more mature infants in their study. In a separate study, Mian et al also reported much lower MV in the first minute directly after birth.16 Other studies reported a higher MV in infants breathing on CPAP, which was mostly due to a higher RR.4,11,17
Management of Extremely Low Birth Weight Infants in Delivery Room
2017, Clinics in PerinatologyCitation Excerpt :Currently, colorimetric CO2 detectors are commonly used in the DR to assess mask ventilation and to confirm correct endotracheal tube placement.76,88,90–92 In addition, several observational studies have described the value of using ECO2 to assess lung aeration and guide respiratory support in the DR.64,93–95 Recent small trials using ECO2 to guide respiratory support at birth reported no difference in admission blood gases96 but a trend to lower rates of BPD.45 Near-infrared spectroscopy (NIRS) allows noninvasive continuous real-time measurement of the regional tissue oxygen saturation.97
Oxygen Saturation and Heart Rate Ranges in Very Preterm Infants Requiring Respiratory Support at Birth
2017, Journal of PediatricsCitation Excerpt :However, in infants of GA 280/7-316/7 weeks, both treatments resulted in similar SpO2. Our data are in agreement with findings reported by Mian et al22 showing that infants receiving CPAP require additional time to clear lung fluid, achieve lung recruitment, and reach SpO2 targets, but in contrast to results of Vento et al,23 who found that preterm infants (GA ≤32 weeks; n = 102) treated with CPAP and air achieved SpO2 targets faster than spontaneously breathing infants. However, Vento et al's study included only infants with a heart rate >100 bpm who did not require supplementary oxygen.
Q.M. was supported in part by an Alberta Innovates, Health Solutions Summer Studentship. M.O’R. is supported by a Molly Towell Perinatal Research Foundation Fellowship. G.S. is a recipient of the Heart and Stroke Foundation/University of Alberta Professorship of Neonatal Resuscitation and a Heart and Stroke Foundation of Canada Research Scholarship. The authors declare no conflicts of interest.