Respiratory Stabilization after Delivery in Term Infants after the Update of the Japan Resuscitation Council Guidelines in 2010

Abstract

Background: The Japan Resuscitation Council (JRC) updated the guidelines for neonatal cardiopulmonary resuscitation in 2010, which recommended appropriate oxygen supplementation under the assessment of oximetry, with continuous positive airway pressure (CPAP) as a consideration in the delivery room. Whether this update has resulted in an improvement of respiratory stabilization in term neonates has not been well investigated to date. Objectives: The aim of this study is to evaluate the impact of the update of the JRC Guidelines in 2010 on the frequency of respiratory support for term neonates within 24 h of life in the nursery or neonatal intensive care unit (NICU). Methods: We conducted a retrospective, single-center study using data of term neonates born between 2008 and 2009 (defined as ‘group 1', before the update of the guidelines), and between 2011 and 2012 (defined as ‘group 2', after the update of the guidelines). We compared resuscitation procedures in the delivery room and respiratory support in the nursery or NICU within 24 h of life between the two groups. Respiratory support included oxygen therapy, nasal CPAP and mechanical ventilation. Results: A total of 5,036 infants were analyzed. In group 2, oxygen administration in the delivery room was significantly decreased (38.9 vs. 22.1%, p < 0.001) and face mask CPAP in the delivery room increased (1.7 vs. 11.1%, p < 0.001). The prevalence of respiratory support within 24 h of life in the nursery or NICU increased significantly in group 2 (group 1, 6.8% vs. group 2, 16.6%, p < 0.001). Conclusions: The update of the JRC Guidelines in 2010 resulted in an increase of respiratory support for term infants within 24 h of life.

Continuous positive airway pressure for term and ≥34+0 weeks’ gestation newborns at birth: A systematic review

“…The systematic review identified two RCTs 22 , 23 and two observational, before-after studies, one of which was divided into two publications. 24 , 25 , 26 Additional data were obtained from one author and included in this meta-analysis. 24 , 25 Characteristics of included studies are reported in Table 1 .…”

“… 24 , 25 , 26 Additional data were obtained from one author and included in this meta-analysis. 24 , 25 Characteristics of included studies are reported in Table 1 .…”

Increased dead space in face mask continuous positive airway pressure in neonates

“…We found that the JRC Guidelines 2010 resulted in an increase in the frequency of face mask CPAP use in the delivery room at term birth and a higher prevalence of pulmonary air leak in early‐term neonates . Furthermore, we found that the updated JRC Guidelines 2010 led to an increase of respiratory support in the nursery or NICU within 24 hr after birth . Based on these results, we suggested that face mask CPAP resulted in higher pressure in the alveoli caused by sudden crying or movement of the infant, which led to pulmonary air leak .…”

“…We also postulated that CPAP in newborns with transient tachypnea may induce over‐distension of part of the lung through check‐valve mechanism of residual fluid in the peripheral airway, leading to pulmonary air leak . Furthermore, we hypothesized that face mask CPAP leads to increased dead space which might increase work of breathing, which in turn leads to tachypnea or larger tidal volume . The present study was focused and conducted to test this hypothesis.…”

“…The usefulness of face mask CPAP in the delivery room; however, has not been discussed adequately. In our previous study, we conducted a retrospective, single‐center study which used data of term neonates born between 2008 and 2009 (before update of guidelines), and between 2011 and 2012 (after update of guidelines) . We compared resuscitation procedures performed in the delivery room, prevalence of pulmonary air leak, and respiratory support in nursery or NICU within 24 hr of life, between the two groups.…”