Decrease in delivery room intubation rates after use of nasal intermittent positive pressure ventilation in the delivery room for resuscitation of very low birth weight infants

Biniwale, Manoj; Wertheimer, Fiona

doi:10.1016/j.resuscitation.2017.05.004

Cited by 22 publications

(23 citation statements)

References 16 publications

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“…38 The authors of a singlecenter study reported decreased DRI rate using modified nasal cannulae. 39 Because both these strategies are still experimental, we did not include them as part of the resuscitation bundle.…”

Section: Discussionmentioning

confidence: 99%

Quality Improvement Project to Decrease Delivery Room Intubations in Preterm Infants

et al. 2019

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Avoiding delivery room intubation (DRI) and stabilization of preterm infants on continuous positive airway pressure (CPAP) reduces death and bronchopulmonary dysplasia (BPD). 1-3 The Neonatal Resuscitation Program (NRP) suggests that spontaneously breathing preterm infants with respiratory distress may be supported with CPAP. 4 However, the majority of extremely low gestational age (GA) neonates receive face mask positive pressure ventilation (Fm-PPV) in the delivery room (DR). 5-7 Inadequate Fm-PPV during these crucial initial minutes after birth may result in persistent hypoxia and bradycardia, necessitating emergent intubation. Airway obstruction 8-10 and mask leak 9, 10 are common during Fm-PPV. The NRP recommends certain steps (mask seal, repositioning head, suction, open mouth, and increase pressure [MRSOP]) to optimize Fm-PPV before resorting to intubation. 11, 12 In addition, the use of colorimetric end-tidal

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Section: Discussionmentioning

confidence: 99%

Quality Improvement Project to Decrease Delivery Room Intubations in Preterm Infants

et al. 2019

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“…The SI in group A was provided by placing the NC into both nostrils, holding the NC with the index finger and closing the mouth with the third to fifth fingers. 8 Subsequently, CPAP of 6 cm H 2 O was applied. The increase in CPAP up to 7 or 8 cm H 2 O was used to reach the oxygen saturation pulse oximeter (SpO 2 ) target, as recommended by the European consensus guidelines for RDS management.…”

Section: Methodsmentioning

confidence: 99%

“…7 Interestingly, authors also used nasal intermittent positive pressure ventilation (NIPPV) as the mode of NIV, with a Tpiece and RAM NC as the patient-nasal interface. In this retrospective study of very low birth weight infants, they showed that positive pressure ventilation (PPV) use in DR using RAM NC resulted in less need for intubation, chest compressions, and epinephrine administration when compared with a face mask for PPV in the DR. 8 Other pulmonary recruitment strategies in the DR, such as the use of sustained inflation (SI) and caffeine in the DR, are currently being evaluated. 9,10 Since November 2016, as part of an ongoing trial named IN-REC-SUR-E (INtubate-RECruit-SURfactant-Extubate), 11 our group has standardized the approach to extremely low GA neonates (ELGANs) in the DR with the use of a protocol that includes SI 9 followed by a nasal continuous positive airway pressure (NCPAP) (range: 6-8 cm of H 2 O) delivered through RAM NC.…”

mentioning

confidence: 99%

Pulmonary Recruitment Strategy in Preterm Neonates < 29 Weeks of Gestational Age to Reduce the Need for Intubation in the Delivery Room

Petrillo¹,

Valenzano²,

Franco³

et al. 2019

Amer J Perinatol

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Background The application of noninvasive ventilation (NIV) modalities from birth in the delivery room (DR) during fetal–neonatal transition reduces the need for invasive mechanical ventilation, mortality, and bronchopulmonary dysplasia (BPD). The use of a RAM nasal cannula (RAM NC) in the DR for resuscitation results in less need for intubation, chest compressions, and epinephrine administration when compared with using a face mask for PPV in the DR. Objective To evaluate the need for endotracheal intubation in the DR among extremely low gestational age neonates treated at birth with sustained inflation (SI) followed by a nasal continuous positive airway pressure (NCPAP) (range: 6–8 cm of H2O) delivered through the RAM NC. Study Design A retrospective study was conducted to compare the use of NIV techniques in the DR and the need for intubation in the DR in premature infants 23 to 28 weeks' gestational age from December 2016 to July 2018 (group A). These data were compared with those of premature inborn infants with similar GA born between April 2015 and November 2016 (group B). In the DR, immediately after birth, neonates in group A received SI through RAM NC followed by CPAP ranging from 6 to 8 cm H2O, whereas the neonates in group B were treated in the DR with SI administered through a face mask followed by the application of CPAP of 5 cm H2O delivered through a nasopharyngeal tube. Results A total of 65 preterm infants 23 to 28 weeks of gestational age, 31 in group A and 34 in group B, were included in the study. The percentage of neonates intubated in the DR was significantly lower in group A (p < 0.008). In both groups, no neonates died in the DR, and no one required epinephrine and/or chest compressions. For those neonates who did not require intubation in the DR, there was no significant difference in the average FiO2 on arrival in the neonatal intensive care unit, rate of intubation within 24 hours, and use of surfactant. The incidence of BPD was similar in the two groups. Only one infant in group A developed moderate BPD, and no one needed oxygen and/or ventilatory assistance at discharge. Mortality was similar in the two groups, with a slight prevalence in group B (27.7 vs. 19.2%). Conclusion SI with RAM NC followed by NCPAP ranging from 6 to 8 cm H2O, administered with RAM NC resulted in a significant reduction of intubation in the DR.

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“…Optimal ETT position was present in 49 and 71% of infants on day 3 and 5, respectively. Infants in the suboptimal ETT position group had a significantly higher proportion of infants weighing < 750 g (59 vs. 41%; p ¼ 0.003), ventilated for significantly longer ( 2) when compared with infants in the optimal ETT position group. Gestation was negatively associated with both invasive (r ¼ -0.41; p < 0.001) and noninvasive ventilation (r ¼ -0.41; p < 0.001), with infants of lower gestation being ventilated for significantly longer periods.…”

Section: Resultsmentioning

confidence: 99%

Weight-Based Guide Overestimates Endotracheal Tube Tip Position in Extremely Preterm Infants

2019

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Objective To evaluate the association between endotracheal tube (ETT) tip position and adverse pulmonary outcomes using chest X-ray (CXR) in extremely preterm infants in whom ETT insertion length was estimated using weight + 6 guide (adding 6 cms to the infant’s weight in kg). Study Design CXRs of 85 infants performed in the first week were reviewed for right-sided atelectasis, air leaks, and uneven lung inflation. The first CXR was later reviewed to document the ETT tip. Regression analysis was performed to find the association between ETT tip position and adverse outcome after adjusting for other confounders. Results Forty (46%) infants had ETT tip placement between the first and second thoracic vertebrae (optimal position) compared with 45 (53%) who had the ETT tip placement outside this range (suboptimal position). Infants with suboptimal ETT were ventilated for a longer period (6.1 vs. 15.9 days; p = 0.004). The odds of adverse outcomes was 11.6 (95% confidence interval: 3.03, 44.1) times higher among infants who did not have ETT at the optimal position compared with infants who had ETT at the optimal position. Conclusion Weight + 6 guide is not recommended to estimate ETT insertion length in extremely preterm infants. Gestation-based guide may be more appropriate to estimate ETT insertion length in this group of infants.

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Decrease in delivery room intubation rates after use of nasal intermittent positive pressure ventilation in the delivery room for resuscitation of very low birth weight infants

Cited by 22 publications

References 16 publications

Quality Improvement Project to Decrease Delivery Room Intubations in Preterm Infants

Quality Improvement Project to Decrease Delivery Room Intubations in Preterm Infants

Pulmonary Recruitment Strategy in Preterm Neonates < 29 Weeks of Gestational Age to Reduce the Need for Intubation in the Delivery Room

Weight-Based Guide Overestimates Endotracheal Tube Tip Position in Extremely Preterm Infants

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