Airway obstruction during mask ventilation of very low birth weight infants during neonatal resuscitation

Neil N Finer, Wade Rich, Casey Wang, Tina Leone
Pediatrics 2009, 123 (3): 865-9

OBJECTIVES: The delivery of adequate but not excessive ventilation remains one of the most common problems encountered during neonatal resuscitation, especially in the very low birth weight infant. Our observations suggest that airway obstruction is a common occurrence after delivery of such infants, and we use colorimetric carbon dioxide detectors during bag-and-mask resuscitation to assist in determining whether the airway was patent. We reviewed our experience to determine the frequency of the occurrence of recognizable airway obstruction during resuscitation of very low birth weight infants.

METHODS AND PATIENTS: The previous prospective trial randomly assigned preterm infants <32 weeks' gestation to resuscitation with either room air or 100% oxygen using pulse oximetry. Colorimetric carbon dioxide detectors were used to assist with bag-and-mask ventilation and to confirm intubation. From the video recordings, the number of positive pressure breaths without a color change in the detector until the breaths were associated with an unequivocal color change was counted as obstructed breaths. From the analog tracings, the number of breaths that had a peak pressure plateau of >/=0.2 second and were not associated with a color change was recorded as the number of obstructed breaths.

RESULTS: None of the studied infants required cardiopulmonary resuscitation or received epinephrine, and all were judged to have an effective circulation during resuscitation. Six of the 24 infants enrolled in the trial received only continuous positive airway pressure. The remaining 18 infants received a median of 14 obstructed breaths (range: 4-37 breaths) delivered over a mean and median interval of 56.7 and 45.0 seconds, respectively (range: 10.0-220.0 seconds). A subgroup of 11 infants was analyzed using airway-pressure data. The target peak inspiratory pressure was 30 cm H(2)O. Ten of these 11 infants had obstructed breaths as defined by no change in the PediCap despite reaching the target pressure for >/=0.2 second.

CONCLUSION: Airway obstruction occurs in the majority of the very low birth weight infants who receive ventilation with a face mask during resuscitation and the use of a colorimetric detector can facilitate its recognition and management.

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