Rescue nasopharyngeal tube for preterm infants non-responsive to initial ventilation after birth

Carina Belting; Christoph M Rüegger; Andreas D Waldmann; Dirk Bassler; Vincent D Gaertner

doi:10.1038/s41390-024-03033-6

Rescue nasopharyngeal tube for preterm infants non-responsive to initial ventilation after birth

Pediatr Res. 2024 Jan 25. doi: 10.1038/s41390-024-03033-6. Online ahead of print.

Authors

Carina Belting^{1

2}, Christoph M Rüegger¹, Andreas D Waldmann³, Dirk Bassler¹, Vincent D Gaertner^{4

5}

Affiliations

¹ Newborn Research, Department of Neonatology, University Hospital and University of Zürich, Zürich, Switzerland.
² Department of Pediatric Intensive Care and Neonatology, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland.
³ Department of Anaesthesiology and Intensive Care Medicine, Rostock University Medical Centre, Rostock, Germany.
⁴ Newborn Research, Department of Neonatology, University Hospital and University of Zürich, Zürich, Switzerland. vincent.gaertner@usz.ch.
⁵ Division of Neonatology, Dr von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Munich, Germany. vincent.gaertner@usz.ch.

PMID: 38273117
DOI: 10.1038/s41390-024-03033-6

Abstract

Background: Physiological changes during the insertion of a rescue nasopharyngeal tube (NPT) after birth are unclear.

Methods: Observational study of very preterm infants in the delivery room. Data were extracted at predefined timepoints starting with first facemask placement after birth until 5 min after insertion of NPT. End-expiratory lung impedance (EELI), heart rate (HR) and SpO₂/FiO₂-ratio were analysed over time. Changes during the same time span of NIPPV via facemask and NIPPV via NPT were compared.

Results: Overall, 1154 inflations in 15 infants were analysed. After NPT insertion, EELI increased significantly [0.33 AU/kg (0.19-0.57), p < 0.001]. Compared with the mask period, changes in EELI were not significantly larger during the NPT period [median difference (IQR) = 0.14 AU/kg (-0.14-0.53); p = 0.12]. Insertion of the NPT was associated with significant improvement in HR [52 (33-96); p = 0.001] and SpO₂/FiO₂-ratio [161 (69-169); p < 0.001] not observed during the mask period.

Conclusions: In very preterm infants non-responsive to initial facemask ventilation after birth, insertion of an NPT resulted in a considerable increase in EELI. This additional gain in lung volume was associated with an immediate improvement in clinical parameters. The use of a NPT may prevent intubation in selected non-responsive infants.

Impact: After birth, a nasopharyngeal tube may be considered as a rescue airway in newborn infants non-responsive to initial positive pressure ventilation via facemask. Although it is widely used among clinicians, its effect on lung volumes and physiological parameters remains unclear. Insertion of a rescue NPT resulted in a considerable increase in lung volume but this was not significantly larger than during facemask ventilation. However, insertion of a rescue NPT was associated with a significant and clinically important improvement in heart rate and oxygenation. This study highlights the importance of individual strategies in preterm resuscitation and introduces the NPT as a valid option.