Evaluating Manual Inflations and Breathing during Mask Ventilation in Preterm Infants at Birth

ObjectiveTo investigate inflations (initial sustained inflations and consecutive inflations) and breathing during mask ventilation in preterm infants at birth.Study designResuscitation of infants <32 weeks' gestation receiving mask ventilation at birth were recorded. Recorded waveforms were divided into inflations (sustained and consecutive inflations), breaths in between inflations, breaths coinciding with an inflation, and breaths on continuous positive airway pressure (during evaluation moments in between and after ventilation) and expiratory tidal volume (VTe) was compared. Inflations were analyzed for leak, low VTe (<2.5 mL/kg), high VTe (>15 mL/kg in sustained inflations, >10 mL/kg in consecutive inflations), and airway obstruction.ResultsIn 27 infants, we analyzed 1643 inflations, 110 breaths in between inflations, 133 breaths coinciding with an inflation, and 1676 breaths on continuous positive airway pressure. A large mask leak frequently resulted in low VTe. Breathing during positive pressure ventilation occurred in 24 of 27 infants (89%). Median (IQR) VTe of inflations, breaths in between inflations, and breaths coinciding with an inflation were 0.8 mL/kg (0.0-5.6 mL/kg), 2.8 mL/kg (0.7-4.6 mL/kg), and 3.9 mL/kg (0.0-7.7 mL/kg) during sustained inflations and 3.7 mL/kg (1.4-6.7 mL/kg), 3.3 mL/kg (2.1-6.6 mL/kg), and 4.6 mL/kg (2.1-7.8 mL/kg) during consecutive inflations, respectively. The VTe of breaths were significantly lower than the VTe of inflations or breaths coinciding with an inflation.ConclusionsWe often observed large leak and low VTe, especially during sustained inflations. Most preterm infants breathe when receiving mask ventilation and this probably contributed to the stabilization of the infants after birth.