Assessment of mouth‐to‐mask ventilation in resuscitation of asphyxic newborn babies. A pilot study

Abstract

The aim of the study was to compare the effectiveness of mouth-to-mask ventilation (MM) in neonatal asphyxia with bag-and-mask ventilation (BM). A new mouth-to-mask infant resuscitation system was constructed. The study was performed in two university clinics with different resources. The KEM Hospital in Bombay was well equipped and neonatologists took part in all resuscitations; Muhimbili Medical Centre in Dar es Salaam was understaffed and had no physicians available at resuscitation. Therefore, different protocols had to be used. In Bombay, the study period was limited to 5 minutes. If needed, mask ventilation was then replaced by intubation. In Dar es Salaam, M M ventilation was continued for up to 10 minutes, the inspiratory pressure was adjusted to 3 0 cmH,O and the ventilation was slow (8-10 breathdmin). In Bombay, 3 0 babies were allocated to the BM and 24 to the M M groups. In Dar es SaIaam 56 were in the BM and 64 in the MM groups.The results for term babies in Bombay and both term and pre-term babies in Dar es Salaam showed no significant differences between the two groups of treatment, as determined by Apgar score 3 4 at 5 and 10 minutes, number of babies with their first gasp, heart rate > 1 3 0 beatdmin or pulse oximeter values above 75%, all at 5 minutes. An Apgar score 3 4 at 5 minutes was achieved in more than 75% of all infants, irrespective of treatment. The rates of early neonatal mortality and neonatal convulsions did not differ between the two methods of resuscitation. associated with a slow increase in heart rate above 130 beats per min. This result indicates that further studies will be needed before such slow respiratory frequencies are used. We conclude that, if adequate training is provided and the respiratory frequency is kept within the normal range, M M ventilation is an alternative to assisted ventilation when no bag and mask is available. However, further studies are necessary, since this method has proved to be tiring and uncomfortable for the resuscitating health personnel.In Dar es Salaam, the low respiratory frequency used in both groups was keywords neonatal resuscitation, mouth-to-mask ventilation, bag-and-mask ventilation, Apgar score, insufflation pressure

Global report on preterm birth and stillbirth (3 of 7): evidence for effectiveness of interventions

“…Massawe et al [192] found that mouth-to-mask and bag-to-mask ventilation were comparable in terms of Apgar scores, heart rate and time to first breath. The only RCT on preterm newborns [189] evaluated the impact of nasal CPAP on BPD and the need for intubation, reporting a lower number of intubations in neonates given nasal CPAP on admission to the NICU compared to those who were not given nCPAP.…”

Reducing one million child deaths from birth asphyxia – a survey of health systems gaps and priorities

“…A variety of technical concerns were noted regarding proper use of resuscitation equipment by CHWs or TBAs, but virtually all respondents considered drying and stimulating the baby and clearing the mouth appropriate tasks, despite the WHO recommendation against clearing the mouth [29]. The virtually unanimous indictment of the mouth-to-tube device, which cannot be used at more than 20 breaths per minute [30], compared to the recommended 40–60 breaths per minute, suggests that use of this technology should be reviewed. Regarding care of the baby with complications of birth asphyxia, most respondents believed referral, keeping the baby dry and warm, and feeding expressed breastmilk were appropriate, emphasizing referral.…”

Laryngeal Mask Airway for neonatal resuscitation in a developing country: evaluation of an educational intervention. Neonatal LMA: an educational intervention in DRC

“…Maintaining a patent airway and providing effective positive pressure ventilation (PPV), which is currently achieved in the delivery room by means of a face mask (FM) or a tracheal tube (TT), is standard treatment and forms the cornerstone of emergency neonatal care in First World countries [2], but making these interventions feasible in settings where resources are limited is particularly challenging [4,5]. Since its introduction into clinical practice, the LMA has gained increasing popularity for resuscitation of adult as well as pediatric patients, and more recently in neonatal resuscitation.…”