Positive End-Expiratory Pressure in Newborn Resuscitation Around Term: A Randomized Controlled Trial
| Autor: | Claus Klingenberg, Hussein Kidanto, Monica Thallinger, Joar Eilevstjønn, Jørgen E. Linde, Hein Stigum, Anita Yeconia, Hege Langli Ersdal, Øystein Gomo, Kari Anne Holte, Ketil Størdal |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Resuscitation Term Birth Birth weight Midwifery Positive-Pressure Respiration Electrocardiography 03 medical and health sciences 0302 clinical medicine Heart Rate Interquartile range 030225 pediatrics medicine Humans Neonatology Positive end-expiratory pressure business.industry Infant Newborn Environmental air flow respiratory system Respiration Artificial respiratory tract diseases Sample Size Anesthesia Pediatrics Perinatology and Child Health Breathing business Infant Premature circulatory and respiratory physiology |
| Zdroj: | Pediatrics. 146 |
| ISSN: | 1098-4275 0031-4005 |
| DOI: | 10.1542/peds.2020-0494 |
| Popis: | 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 CO2 (2.9 [1.5–4.3] vs 3.3 [1.9–5.0] %; P = .05). Twenty four-hour mortality was 9% in both groups. 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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