Journal of paediatrics and child health
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The lungs of an extremely preterm infant ≤28 weeks gestation are structurally and biochemically immature and vulnerable to injury from positive pressure ventilation. A lung protective approach to respiratory support is vital, aiming to ventilate an open lung, using the lowest pressure settings that maintain recruitment and oxygenation and avoiding hyperinflation with each tidal breath. ⋯ Many extremely preterm infants have minimal atelectasis and low oxygen requirements in the first days of life, and the ventilatory approach in this case should be one of avoidance of factors including overdistension that are known to contribute to later pulmonary deterioration. From a practical perspective, this means setting positive end-expiratory pressure at the lowest value that maintains oxygenation and restricting tidal volume using a volume-targeted mode of ventilation.
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J Paediatr Child Health · Sep 2012
ReviewTurn and face the strange - ch..ch..ch..changes to neonatal resuscitation guidelines in the past decade.
Resuscitation of newborns has been described since ancient times and is among the most commonly performed emergency medical interventions. The International Liaison Committee on Resuscitation first made recommendations on resuscitation in newborns in 1999. Over the last decade, new research and careful review of the available evidence have resulted in substantial changes to these recommendations - in particular, regarding the assessment of colour, giving supplemental oxygen, suctioning infants born through meconium-stained liquor, confirming endotracheal tube position, the use of pulse oximetry, giving CPAP to premature infants, keeping preterm infants warm using polyethylene wrapping and cooling term infants with encephalopathy. This process has also highlighted the paucity of evidence to support much of the care given to infants in the delivery room and the need for research to refine our techniques.
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J Paediatr Child Health · Sep 2012
ReviewNasal continuous positive airway pressure for respiratory distress in non-tertiary care centres: what is needed and where to from here?
Respiratory distress is one of the commonest reasons for admission to a special care nursery (SCN) affecting between 2.5 and 5.0% of all babies born per year. While most recover with supplemental oxygen, some require transfer to a neonatal intensive care leading to significant family disruption, and financial cost. ⋯ The risk benefit ratio of providing nCPAP in SCNs depends upon many factors including the ability to maintain the skills required and the distance/time to the nearest tertiary centre. Appropriate nurseries should be identified with the aim of supporting them in the provision of nCPAP in a safe manner.
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J Paediatr Child Health · Sep 2012
Use of oxygen for delivery room neonatal resuscitation in non-tertiary Australian and New Zealand hospitals: a survey of current practices, opinions and equipment.
Delivery room resuscitation of hypoxic newborn infants with pure or 100% oxygen causes oxidative toxicity and increases mortality. Current international resuscitation guidelines therefore recommend that oxygen be used judiciously. However, this requires staff education and special equipment that may not be available in non-tertiary maternity hospitals where the majority of births occur. ⋯ Only one in five ANZ non-tertiary maternity hospitals had the capacity to resuscitate newborn infants with air or blended oxygen. Most are aware of current recommendations and agreed that the use of less oxygen would be beneficial for this purpose. Further study into the necessary infrastructure required to implement these guidelines are recommended.