Monitoring lung aeration during respiratory support in preterm infants at birth

Liane J Kang; Po-Yin Cheung; Gerhard Pichler; Megan O'Reilly; Khalid Aziz; Georg M Schmölzer

doi:10.1371/journal.pone.0102729

Monitoring lung aeration during respiratory support in preterm infants at birth

PLoS One. 2014 Jul 16;9(7):e102729. doi: 10.1371/journal.pone.0102729. eCollection 2014.

Authors

Liane J Kang¹, Po-Yin Cheung¹, Gerhard Pichler², Megan O'Reilly¹, Khalid Aziz¹, Georg M Schmölzer²

Affiliations

¹ Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Canada; Neonatal Research Unit, Royal Alexandra Hospital, Alberta Health Services, Edmonton, Canada.
² Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Canada; Neonatal Research Unit, Royal Alexandra Hospital, Alberta Health Services, Edmonton, Canada; Division of Neonatology, Department of Pediatrics, Medical University, Graz, Austria.

Abstract

Background: If infants fail to initiate spontaneous breathing, resuscitation guidelines recommend respiratory support with positive pressure ventilation (PPV). The purpose of PPV is to establish functional residual capacity and deliver an adequate tidal volume (VT) to achieve gas exchange.

Objective: The aim of our pilot study was to measure changes in exhaled carbon dioxide (ECO2), VT, and rate of carbon dioxide elimination (VCO2) to assess lung aeration in preterm infants requiring respiratory support immediately after birth.

Method: A prospective observational study was performed between March and July 2013. Infants born at <37 weeks gestational age who received continuous positive airway pressure (CPAP) or PPV immediately after birth had VT delivery and ECO2 continuously recorded using a sensor attached to the facemask.

Results: Fifty-one preterm infants (mean (SD) gestational age 29 (3) weeks and birth weight 1425 (592 g)) receiving respiratory support in the delivery room were included. Infants in the CPAP group (n = 31) had higher ECO2 values during the first 10 min after birth compared to infants receiving PPV (n = 20) (ranging between 18-30 vs. 13-18 mmHg, p<0.05, respectively). At 10 min no significant difference in ECO2 values was observed. VT was lower in the CPAP group compared to the PPV group over the first 10 min ranging between 5.2-6.6 vs. and 7.2-11.3 mL/kg (p<0.05), respectively.

Conclusions: Immediately after birth, spontaneously breathing preterm infants supported via CPAP achieved better lung aeration compared to infants requiring PPV. PPV guided by VT and ECO2 potentially optimize lung aeration without excessive VT administered.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Blood Pressure
Carbon Dioxide / metabolism*
Heart Rate
Humans
Infant, Newborn
Infant, Premature / physiology*
Positive-Pressure Respiration / methods*
Premature Birth / physiopathology*
Prospective Studies
Pulmonary Elimination / physiology
Respiratory Rate
Statistics, Nonparametric
Tidal Volume / physiology*

Substances

Carbon Dioxide

Grants and funding

LK is a recipient of the summer studentship from the Faculty of Medicine and Dentistry, University of Alberta and Neonatal Research Fund, Alberta Health Services. GMS is a recipient of a Banting Postdoctoral Fellowship, Canadian Institutes of Health Research and an Alberta Innovates - Health Solutions Clinical Fellowship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.