Self-inflating bags did not reliably provide the desired PEEP of 5 cmH (2)O, whereas T-piece resuscitators did reliably provide the set PEEP-level, with less variability. When using self-inflating bags with PEEP-valves, neonatologists should check the equipment regarding the reliability of PEEP provision.
BackgroundSurveys from the USA, Australia and Spain have shown significant inter-institutional variation in delivery room (DR) management of very low birth weight infants (VLBWI, < 1500 g) at birth, despite regularly updated international guidelines.ObjectiveTo investigate protocols for DR management of VLBWI in Germany, Austria and Switzerland and to compare these with the 2005 ILCOR guidelines.MethodsDR management protocols were surveyed in a prospective, questionnaire-based survey in 2008. Results were compared between countries and between academic and non-academic units. Protocols were compared to the 2005 ILCOR guidelines.ResultsIn total, 190/249 units (76%) replied. Protocols for DR management existed in 94% of units. Statistically significant differences between countries were found regarding provision of 24 hr in house neonatal service; presence of a designated resuscitation area; devices for respiratory support; use of pressure-controlled manual ventilation devices; volume control by respirator; and dosage of Surfactant. There were no statistically significant differences regarding application and monitoring of supplementary oxygen, or targeted saturation levels, or for the use of sustained inflations. Comparison of academic and non-academic hospitals showed no significant differences, apart from the targeted saturation levels (SpO2) at 10 min. of life. Comparison with ILCOR guidelines showed good adherence to the 2005 recommendations.SummaryDelivery room management in German, Austrian and Swiss neonatal units was commonly based on written protocols. Only minor differences were found regarding the DR setup, devices used and the targeted ranges for SpO2 and FiO2. DR management was in good accordance with 2005 ILCOR guidelines, some units already incorporated evidence beyond the ILCOR statement into their routine practice.
Introduction: Self-inflating (SI) bags and T-piece resuscitators are used for mask ventilation of neonates. Leaks between face and mask occur frequently. Little is known about the effects of mask leak on applied pressure and volume. We investigated these effects in an in-vitro study.
Abstractsof pressurization and variation in hand hold, influencing measurements. Aim To investigate whether mask volume varies during mask ventilation and influences measured tidal volumes and calculated mask leak. Methods Thirty caregivers of the neonatal unit were asked to mask-ventilate a leak free manikin with pressures 25/5 cm H 2 O and a gas flow rate of 6 and 10 L/min. A Laerdal 0/1 mask (40 mL) was glued leak free on the face in the right position but the participant was unaware why the mask position was fixed. The participant was told that mask hold, not positioning, was tested and that it was still possible to have leak. Tidal volumes were measured using a RFM. Results Inspired tidal volume (V Ti ) increased from 8.05 mL (0.76) at 6 L/min to 8.76 mL (0.75) at 10 L/min (p<0.01) and expired tidal volume (V Te ) from 8.15 mL (0.81)) at 6 L/min to 8.85 mL (0.75) at 10 L/min (p<0.001). Median (IQR) leak was -0.90 (-3.90-1.40) % with 6 L/min and did not increase with 10 L/min (-0.62 (-3.43-1.80
Abstractscorrect ETT, 2. Assess PTU as a recordable accurate tool to document ETT position prior to surfactant administration to improve the 'golden hour management'. Methods Single centre prospective study involving ELBW neonates < 1000 gm requiring intubation post-delivery. Two recordings per infant were done -one in delivery room and second when the infant reaches NICU. Accuracy of PTU (Micromaxx®) was compared with clinical assessments, colorimetric CO 2 detection and Chest X-ray ETT position. Single operator conduced examinations who was not part of the resuscitation team. Hospital Research and Ethics committee approval was obtained. Results Seventeen ELBW infants had PTU in labour delivery room (n=17) yielding 34 recordings. For 5 out of 17 (29.4%) infants significant improvement of ETT position could be offered by the use of PTU which otherwise was not detected. It is feasible to measure and record diaphragmatic excursion bilaterally during the labour ward resuscitation environment. The diagnostic accuracy of PTU for correct ETT was greater than that by traditional clinical methods and colorimetric CO 2 detection. Inter-operator consistency and value of hand-held device (VScan®) is being evaluated. Conclusion PTU is a valuable adjunct tool to record symmetry of diaphragmatic movement as a measure of correct ETT placement in labour ward for ELBW infants. HIGH-FLOW NASAL CANNULAE FOR RESPIRATORY SUPPORT OF PRETERM INFANTS: A REVIEW OF THE EVIDENCE Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, AustraliaBackground High-flow nasal cannulae (HFNC) are gaining in popularity as a form of non-invasive respiratory support for preterm infants in neonatal intensive care units around the world. They are proposed as an alternative to nasal continuous positive airway pressure (NCPAP) for treating respiratory distress in a variety of clinical situations, including post-extubation support, primary therapy from birth, and to 'wean' from NCPAP. Objectives To present and discuss the available evidence for the use of HFNC in various roles in the preterm population. Methods We performed an internet-based literature search for relevant, original research articles (both randomised and not) on the use of HFNC in preterm infants. Results 18 studies were included in the review. Distending pressure generated by HFNC in preterm infants increases with increasing flow rate and decreasing infant size, and may vary according to the amount of leak around the prongs. HFNC may be as effective as NCPAP at improving respiratory parameters such as tidal volume and work of breathing in preterm infants, but perhaps only at flow rates >2 Litres per minute. Based on available published evidence, the efficacy and safety of HFNC in preterm infants remain to be determined. Conclusions There is increasing evidence from clinical trials to support the use of HFNC treatment of preterm infants with respiratory failure, however uncertainty remains about efficacy, safety and optimal flow rates. Until the results of ...
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