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Am J Perinatol 2019; 36(13): 1368-1376
DOI: 10.1055/s-0038-1676828
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

New Strategies of Pulmonary Protection of Preterm Infants in the Delivery Room with the Respiratory Function Monitoring

Gonzalo Zeballos Sarrato
1   Division of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
,
Manuel Sánchez Luna
1   Division of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
,
Susana Zeballos Sarrato
1   Division of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
,
Alba Pérez Pérez
1   Division of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
,
Isabel Pescador Chamorro
1   Division of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
,
Jose María Bellón Cano
2   Division of Neonatology, Department of Statistics Institute for Health Research, Hospital General Universitario Gregorio Marañón, Madrid, Spain
› Author Affiliations
Further Information

Publication History

05 June 2018

16 November 2018

Publication Date:
08 January 2019 (online)

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Abstract

Objective To investigate if the use of a visible respiratory function monitor (RFM) to use lower tidal volumes (Vts) during positive pressure ventilation (PPV) in the delivery room (DR) reduces the need of surfactant administration and invasive mechanical ventilation during the first 72 hours after birth of preterm infants <32 weeks' gestational age (GA).

Study Design Infants <32 weeks' GA (n = 106) requiring noninvasive PPV were monitored with a RFM at birth and randomized to visible (n = 54) or masked (n = 52) display on RFM. Pulmonary data were recorded during the first 10 minutes after birth. Secondary analysis stratified patients by GA (<28, 28–29+6, or ≥30 weeks).

Results Median expiratory Vts during inflations were greater in the masked group (7 mL/kg) than in the visible group (5.8 mL/kg; p = 0.001) same as peak inflation pressure (PIP) administered (21.5 vs. 19.7 cmH2O; p < 0.001). Consequently, minute volumes were greater in the masked group (256 vs. 214 mL/kg/min; p < 0.001), with no differences in respiratory rate. These differences were higher in those <30 weeks' GA. There was no difference in the need of surfactant administration or intubation during the first 72 hours of age.

Conclusion Using a RFM in the DR prevents the use of large Vt and PIP during respiratory support inflations, mostly in the more immature newborn infants, but with no other short-term benefits.

Keywords

tidal volume - respiratory function monitor - stabilization - ventilation - preterm infant

Ethical Approval

The Gregorio Marañón University Hospital Research and Ethics Committees provided Ethics approval.