Positive End-Expiratory Pressure in Newborn Resuscitation Around Term: A Randomized Controlled Trial.
| Autor: | Holte K; Department of Pediatrics and Adolescence Medicine, Østfold Hospital Trust, Grålum, Norway; kari.holte@so-hf.no.; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway., Ersdal H; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.; Departments of Anesthesiology and Intensive Care., Eilevstjønn J; Strategic Research Department, Laerdal Medical, Stavanger, Norway., Gomo Ø; Strategic Research Department, Laerdal Medical, Stavanger, Norway., Klingenberg C; Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway.; Pediatric Research Group, Faculty of Health Sciences, University of Tromsø-Arctic University of Norway, Tromsø, Norway., Thallinger M; Department of Anesthesiology and Intensive Care, Vestre Viken Hospital Trust, Bærum, Norway., Linde J; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.; Pediatrics and Adolescence Medicine, and., Stigum H; Norwegian Institute of Public Health, Oslo, Norway., Yeconia A; Haydom Lutheran Hospital, Mbulu, Manyara, Tanzania; and., Kidanto H; Research, Stavanger University Hospital, Stavanger, Norway.; Medical College, Agakhan University, Dar es Salaam, Tanzania., Størdal K; Department of Pediatrics and Adolescence Medicine, Østfold Hospital Trust, Grålum, Norway.; Norwegian Institute of Public Health, Oslo, Norway. |
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| Jazyk: | angličtina |
| Zdroj: | Pediatrics [Pediatrics] 2020 Oct; Vol. 146 (4). Date of Electronic Publication: 2020 Sep 11. |
| DOI: | 10.1542/peds.2020-0494 |
| Abstrakt: | Background: International guidelines for resuscitation recommend using positive end-expiratory pressure (PEEP) during ventilation of preterm newborns. Reliable PEEP-valves for self-inflating bags have been lacking, and effects of PEEP during resuscitation of term newborns are insufficiently studied. The objective was to determine if adding a new PEEP valve to the bag-mask during resuscitation of term and near-term newborns could improve heart rate response. Methods: This randomized controlled trial was performed at Haydom Lutheran Hospital in Tanzania (September 2016 to June 2018). Helping Babies Breathe-trained midwives performed newborn resuscitation using self-inflating bags with or without a new, integrated PEEP valve. All live-born newborns who received bag-mask ventilation at birth were eligible. Heart rate response measured by ECG was the primary outcome, and clinical outcome and ventilation data were recorded. Results: Among 417 included newborns (median birth weight 3200 g), 206 were ventilated without and 211 with PEEP. We found no difference in heart rate response. Median (interquartile range) measured PEEP in the PEEP group was 4.7 (2.0-5.6) millibar. The PEEP group received lower tidal volumes (4.9 [1.9-8.2] vs 6.3 [3.9-10.5] mL/kg; P = .02) and had borderline lower expired CO Conclusions: We found no evidence for improved heart rate response during bag-mask ventilation with PEEP compared with no PEEP. The PEEP valve delivered a median PEEP within the intended range. The findings do not support routine use of PEEP during resuscitation of newborns around term. Competing Interests: POTENTIAL CONFLICT OF INTEREST: Dr Eilevstjønn and Mr Gomo are employees at Laerdal Medical. Jørgen Linde is married to an employee at Laerdal Global Health; the other authors have indicated they have no potential conflicts of interest to disclose. (Copyright © 2020 by the American Academy of Pediatrics.) |
| Databáze: | MEDLINE |
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