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Tidal Volumes in Spontaneously Breathing Preterm Infants Supported with Continuous Positive Airway Pressure

      Objective

      To describe changes in tidal volume (VT) and their correlation to changes in oxygen saturation and heart rate in spontaneously breathing preterm infants immediately after birth.

      Study design

      In this prospective observational, 2-center study, a flow sensor was attached to the facemask of spontaneously breathing infants born at <37 weeks' gestational age who received continuous positive airway pressure (CPAP) immediately after birth. Respiratory function, heart rate, and oxygen saturation were continuously recorded during spontaneous breathing.

      Results

      Fifty-five infants (mean [SD] gestational age 31 [26-36] weeks and birth weight 1647 [500] g) received mask CPAP in the delivery room. CPAP was started at a median (IQR) 90 (60-118) seconds after birth and was delivered for 720 (300-900) seconds. Median VT ranged between 4.2 and 5.8 mL/kg with the individual VT varied between 0.9 and 19.8 mL/kg. Overall, VT increased over the first few minutes after birth and decreased thereafter. The increase in saturation after birth lagged behind the published normal ranges for spontaneously breathing preterm infants without CPAP.

      Conclusions

      The 50th percentile for spontaneous VT in preterm infants during mask CPAP ranged from 4.2 to 5.8 mL/kg, with wide individual variation observed in the first minutes after birth. Preterm infants requiring CPAP after birth may take longer to achieve so-called “normal” saturation targets.
      CPAP (Continuous positive airway pressure), FiO2 (Fraction of inspired oxygen), HR (Heart rate), PEEP (Positive end-expiratory pressure), SpO2 (Oxygen saturation), VT (Tidal volume)
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      References

        • te Pas A.B.
        • Davis P.G.
        • Hooper S.B.
        • Morley C.J.
        From liquid to air: breathing after birth.
        J Pediatr. 2008; 152: 607-611
        • Schmölzer G.M.
        • te Pas A.B.
        • Davis P.G.
        • Morley C.J.
        Reducing lung injury during neonatal resuscitation of preterm infants.
        J Pediatr. 2008; 153: 741-745
        • O'Donnell C.P.
        • Kamlin C.O.
        • Davis P.G.
        • Morley C.J.
        Crying and breathing by extremely preterm infants immediately after birth.
        J Pediatr. 2010; 156: 846-847
        • Aziz K.
        • Chadwick M.
        • Baker M.
        • Andrews W.
        Ante- and intra-partum factors that predict increased need for neonatal resuscitation.
        Resuscitation. 2008; 79: 444-452
        • Kattwinkel J.
        • Stewart C.
        • Walsh B.
        • Gurka M.
        • Paget-Brown A.
        Responding to compliance changes in a lung model during manual ventilation: perhaps volume, rather than pressure, should be displayed.
        Pediatrics. 2009; 123: e465-e470
        • Bowman T.A.
        • Paget-Brown A.
        • Carroll J.
        • Gurka M.J.
        • Kattwinkel J.
        Sensing and responding to compliance changes during manual ventilation using a lung model: can we teach healthcare providers to improve?.
        J Pediatr. 2012; 160: 372-376.e1
        • Schmölzer G.M.
        • Kamlin C.O.
        • O'Donnell C.P.
        • Dawson J.A.
        • Morley C.J.
        • Davis P.G.
        Assessment of tidal volume and gas leak during mask ventilation of preterm infants in the delivery room.
        Arch Dis Child Fetal Neonatal Ed. 2010; 95: F393-F397
        • Poulton D.A.
        • Schmölzer G.M.
        • Morley C.J.
        • Davis P.G.
        Assessment of chest rise during mask ventilation of preterm infants in the delivery room.
        Resuscitation. 2011; 82: 175-179
        • Schmölzer G.M.
        • Morley C.J.
        • Wong C.
        • Dawson J.A.
        • Kamlin C.O.
        • Donath S.M.
        • et al.
        Respiratory function monitor guidance of mask ventilation in the delivery room: a feasibility study.
        J Pediatr. 2012; 160: 377-381.e2
        • te Pas A.B.
        • Wong C.
        • Kamlin C.O.
        • Dawson J.A.
        • Morley C.J.
        • Davis P.G.
        Breathing patterns in preterm and term infants immediately after birth.
        Pediatr Res. 2009; 65: 352-356
        • te Pas A.B.
        • Davis P.G.
        • Kamlin C.O.
        • Dawson J.
        • O'Donnell C.P.
        • Morley C.J.
        Spontaneous breathing patterns of very preterm infants treated with continuous positive airway pressure at birth.
        Pediatr Res. 2008; 64: 281-285
        • Schilleman K.
        • van der Pot C.J.
        • Hooper S.B.
        • Lopriore E.
        • Walther F.J.
        • te Pas A.B.
        Evaluating manual inflations and breathing during mask ventilation in preterm infants at birth.
        J Pediatr. 2013; 162: 457-463
        • Kaufman J.
        • Schmölzer G.M.
        • Kamlin C.O.
        • Davis P.G.
        Mask ventilation of preterm infants in the delivery room.
        Arch Dis Child Fetal Neonatal Ed. 2013; 98: F405-F410
        • O'Donnell C.P.
        • Kamlin C.O.
        • Davis P.G.
        • Morley C.J.
        Neonatal resuscitation 1: a model to measure inspired and expired tidal volumes and assess leakage at the face mask.
        Arch Dis Child Fetal Neonatal Ed. 2005; 90: F388-F391
        • Cole T.J.
        • Green P.J.
        Smoothing reference centile curves: the LMS method and penalized likelihood.
        Stat Med. 1992; 11: 1305-1319
        • Dawson J.A.
        • Kamlin C.O.
        • Vento M.
        • Wong C.
        • Cole T.J.
        • Donath S.M.
        • et al.
        Defining the reference range for oxygen saturation for infants after birth.
        Pediatrics. 2010; 125: e1340-e1347
        • Kattwinkel J.
        • Perlman J.M.
        • Aziz K.
        • Colby C.
        • Fairchild K.
        • Gallagher J.
        • et al.
        Part 15: neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
        Circulation. 2010; 122: S909-S919
        • Björklund L.J.
        • Ingimarsson J.
        • Curstedt T.
        • John J.
        • Robertson B.
        • Werner O.
        • et al.
        Manual ventilation with a few large breaths at birth compromises the therapeutic effect of subsequent surfactant replacement in immature lambs.
        Pediatr Res. 1997; 42: 348-355
        • Hillman N.H.
        • Kallapur S.G.
        • Pillow J.J.
        • Moss T.J.
        • Polglase G.R.
        • Nitsos I.
        • et al.
        Airway injury from initiating ventilation in preterm sheep.
        Pediatr Res. 2010; 67: 60-65
        • Hillman N.H.
        • Moss T.J.
        • Kallapur S.G.
        • Bachurski C.
        • Pillow J.J.
        • Polglase G.R.
        • et al.
        Brief, large tidal volume ventilation initiates lung injury and a systemic response in fetal sheep.
        Am J Respir Crit Care Med. 2007; 176: 575-581
        • Polglase G.R.
        • Miller S.L.
        • Barton S.K.
        • Baburamani A.A.
        • Wong F.Y.
        • Aridas J.D.
        • et al.
        Initiation of resuscitation with high tidal volumes causes cerebral hemodynamic disturbance, brain inflammation and injury in preterm lambs.
        PLoS One. 2012; 7: e39535
        • Schilleman K.
        • Siew M.L.
        • Lopriore E.
        • Morley C.J.
        • Walther F.J.
        • te Pas A.B.
        Auditing resuscitation of preterm infants at birth by recording video and physiological parameters.
        Resuscitation. 2012; 83: 1135-1139
        • Karlberg P.
        • Cherry R.B.
        • Escardo F.E.
        • Koc G.
        Respiratory Studies in Newborn Infants. II: pulmonary ventilation and mechanics of breathing in the first minutes of life, including the onset of respiration.
        Acta Paediatr. 1962; 51: 121-136
        • Dawson J.A.
        • Kamlin C.O.
        • Wong C.
        • te Pas A.B.
        • Vento M.
        • Cole T.J.
        • et al.
        Changes in heart rate in the first minutes after birth.
        Arch Dis Child Fetal Neonatal Ed. 2010; 95: F177-F181
        • Vento M.
        • Cubells E.
        • Escobar J.J.
        • Escrig R.
        • Aguar M.
        • Brugada M.
        • et al.
        Oxygen saturation after birth in preterm infants treated with continuous positive airway pressure and air: assessment of gender differences and comparison with a published nomogram.
        Arch Dis Child Fetal Neonatal Ed. 2013; 98: F228-F232
        • Karlberg P.
        • Koch G.
        • Wallgren G.
        • Geubelle F.
        Respiratory studies in newborns.
        Acta Paediatr Suppl. 1959; 48: 128-130
        • te Pas A.B.
        • Siew M.L.
        • Wallace M.J.
        • Kitchen M.J.
        • Fouras A.
        • Lewis R.A.
        • et al.
        Establishing functional residual capacity at birth: the effect of sustained inflation and positive end-expiratory pressure in a preterm rabbit model.
        Pediatr Res. 2009; 65: 537-541
        • Siew M.L.
        • te Pas A.B.
        • Wallace M.J.
        • Kitchen M.J.
        • Lewis R.A.
        • Fouras A.
        • et al.
        Positive end-expiratory pressure enhances development of a functional residual capacity in preterm rabbits ventilated from birth.
        J Appl Physiol (1985). 2009; 106: 1487-1493
        • Boon A.W.
        • Milner A.D.
        • Hopkin I.E.
        Lung expansion, tidal exchange, and formation of the functional residual capacity during resuscitation of asphyxiated neonates.
        J Pediatr. 1979; 95: 1031-1036
        • Mortola J.P.
        • Fisher J.T.
        • Smith J.B.
        • Fox G.S.
        • Weeks S.
        • Willis D.
        Onset of respiration in infants delivered by cesarean section.
        J Appl Physiol Respir Environ Exerc Physiol. 1982; 52: 716-724