Supporting breathing of preterm infants at birth: a narrative review

Most very preterm infants have difficulty aerating their lungs and require respiratory support at birth. Currently in clinical practice, non-invasive ventilation in the form of continuous positive airway pressure (CPAP) and positive pressure ventilation (PPV) is applied via facemask. As most very pr...

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Published inArchives of disease in childhood. Fetal and neonatal edition Vol. 104; no. 1; pp. F102 - F107
Main Authors Martherus, Tessa, Oberthuer, André, Dekker, Janneke, Hooper, Stuart B, McGillick, Erin V, Kribs, Angela, te Pas, Arjan B
Format Journal Article
LanguageEnglish
Published England BMJ Publishing Group LTD 01.01.2019
Subjects
Babies
Brain
Continuous positive airway pressure
Gas flow
Infants
Larynx
Lungs
Masks
Newborn babies
Pediatrics
Physiology
Premature babies
Premature birth
Respiration
Respiratory therapy
Ventilation
Ventilators
physiology
resuscitation
neonatology
technology
respiratory
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Summary:Most very preterm infants have difficulty aerating their lungs and require respiratory support at birth. Currently in clinical practice, non-invasive ventilation in the form of continuous positive airway pressure (CPAP) and positive pressure ventilation (PPV) is applied via facemask. As most very preterm infants breathe weakly and unnoticed at birth, PPV is often administered. PPV is, however, frequently ineffective due to pressure settings, mask leak and airway obstruction. Meanwhile, high positive inspiratory pressures and spontaneous breathing coinciding with inflations can generate high tidal volumes. Evidence from preclinical studies demonstrates that high tidal volumes can be injurious to the lungs and brains of premature newborns. To reduce the need for PPV in the delivery room, it should be considered to optimise spontaneous breathing with CPAP. CPAP is recommended in guidelines and commonly used in the delivery room after a period of PPV, but little data is available on the ideal CPAP strategy and CPAP delivering devices and interfaces used in the delivery room. This narrative review summarises the currently available evidence for why PPV can be inadequate at birth and what is known about different CPAP strategies, devices and interfaces used the delivery room.
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ISSN:1359-2998
1468-2052
DOI:10.1136/archdischild-2018-314898