The Danger of Mouth-to-Mouth Breathing in Resuscitation of the New-Born Infant

Abstract

Of the various modes of resuscitating an asphyxiated new-born infant, direct mouth-to-mouth insufflation of the lungs enjoys great popularity among practitioners. Although it is probably the easiest and quickest method of filling the collapsed lungs of the child with air, the danger of rupturing the delicate alveoli by too much force, and of producing a pneumothorax is considerable. For this reason many authors either warn against its use altogether or sponsor it only if most painstaking precautions are observed.How well founded their objections are may be seen from the following case. REPORT OF CASEA sextipara, aged 42, near term, was admitted to the hospital with profuse bleeding. The cause of the bleeding was a placenta praevia centralis, and as the case was further complicated by a transverse position of the fetus, cesarean section was decided on and performed by the chief of the department, Dr. George Gellhorn. The infant, a boy, apparently a little below the average weight, was extracted and handed over to an intern, who attended to the care of the umbilical cord in an adjoining room. Presently, there was a weak cry, and the infant was taken to the nursery on another floor of the building. After the completion of the operation, the nurse in charge reported that the infant appeared normal at first, but soon became cyanotic and breathed irregularly. On examination, the color of the skin was found to be deep blue, and the respiration was rapid and shallow. The infant continuously emitted moaning and whining sounds. Only when oxygen was administered and external heat applied did the condition improve a little, but the improvement was of short duration.The pediatrician on duty, Dr. T. Wistar White, who was notified at once and arrived a few minutes before the infant died, suggested that an x-ray picture be taken. The picture (figure) revealed "a complete atelectasis of the right lung. The left lung was also collapsed and pushed to the midline by a large accumula¬ tion of air in the thoracic cavity. A dense triangular shadow in the upper portion of the chest was suggestive of a large thymus. The cardiac shadow did not seem to be enlarged." (Dr. L. R. Sante.)These observations could be interpreted either as a congenital anomaly such as a pulmonary fistula or as the result of traumatism. Before assuming the former and rather far-fetched possibility, the intern who had taken charge of the

Spontaneous Pneumothorax in the Newborn

“…The findings on physical examination were entirely normal. The birth weight was 7 pounds 7y2 ounces (3,375 Gm. ).…”

“…C) revealed complete clearing of the pneumothorax. The infant was then given breast feedings again with a supplementary feeding of the formula and was dis¬ charged on December 5 with a weight of 6 pounds and 14 ounces (3,118 Gm. ).…”