New Strategies of Pulmonary Protection of Preterm Infants in the Delivery Room with the Respiratory Function Monitoring.

OBJECTIVE:  To investigate if the use of a visible respiratory function monitor (RFM) to use lower tidal volumes (Vts) during positive pressure ventilation (PPV) in the delivery room (DR) reduces the need of surfactant administration and invasive mechanical ventilation during the first 72 hours after birth of preterm infants <32 weeks' gestational age (GA).

STUDY DESIGN:  Infants <32 weeks' GA ( n  = 106) requiring noninvasive PPV were monitored with a RFM at birth and randomized to visible ( n  = 54) or masked ( n  = 52) display on RFM. Pulmonary data were recorded during the first 10 minutes after birth. Secondary analysis stratified patients by GA (<28, 28-29+6 , or ≥30 weeks).

RESULTS:  Median expiratory Vts during inflations were greater in the masked group (7 mL/kg) than in the visible group (5.8 mL/kg; p  = 0.001) same as peak inflation pressure (PIP) administered (21.5 vs. 19.7 cmH2 O; p  < 0.001). Consequently, minute volumes were greater in the masked group (256 vs. 214 mL/kg/min; p  < 0.001), with no differences in respiratory rate. These differences were higher in those <30 weeks' GA. There was no difference in the need of surfactant administration or intubation during the first 72 hours of age.

CONCLUSION:  Using a RFM in the DR prevents the use of large Vt and PIP during respiratory support inflations, mostly in the more immature newborn infants, but with no other short-term benefits.