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NEONATAL SOCIETY ABSTRACTS

Inflation breaths versus sustained inflations during stabilization at delivery of prematurely-born infants

Presented at the Neonatal Society 2018 Spring Meeting (programme).

Hunt K, Dassios T, Ali K, Milner A, Greenough A

King’s College London, UK
King’s College Hospital, UK

Background: The time taken for an infant to initiate respiratory effort during resuscitation after delivery is inversely related to inflation time (1). There have been several studies that have suggested that a sustained inflation (SI) may be advantageous (2,3}, but there have been no studies comparing SI to the current UK NLS guideline of five inflations each of 2-3 seconds. We hypothesised that a fifteen second SI, compared to five shorter inflations would promote faster initiation of breathing after delivery in prematurely-born infants requiring resuscitation.

Methods: Respiratory function monitoring was performed at deliveries of infants born at less than 34 weeks of gestational age. Infants were randomised to standard inflations (five inflations each lasting two to three seconds) or a fifteen second sustained inflation if the clinical team felt that resuscitation was required; both could be repeated if necessary. Stabilisation was then continued as usual. The study was approved by the London – Riverside NHS Research Ethics Committee as emergency research and to be carried out without prior consent. Parents were approached after the study for consent to retain and analyse the data.

Results: Sixty one infants were randomised, but the results of two infants were excluded due to a very high leak making their traces impossible to interpret. There were no significant differences between the sustained inflation or 2-3 second inflation breath groups regarding gestational age (30+3 versus 29+5 weeks, p=0.2) or birthweight (1186 versus 1001g, p=0.1). Infants who received sustained inflations had a shorter time to the first breath (3.5 vs 16.1 seconds, p=0.001), and were mechanically ventilated for a shorter amount of time in the first 48 hours (17 vs 32.5 hours, p=0.025). When infants who breathed sooner than the average length of a 2-3 second inflation were excluded, those who received sustained inflations again breathed significantly sooner (5.9 vs 19.3 seconds, p=0.019) and were ventilated for significantly less time in the first 48 hours (17.5 vs 48 hours, p=0.014).

Conclusion: A fifteen second sustained inflation compared to five 2-3 second inflations during initial resuscitation of infants born at less than 34 weeks gestation resulted in a shorter time to the first breath and a shorter duration of mechanical ventilation in the first 48 hours after birth.

Corresponding author: anne.greenough@kcl.ac.uk

References
1. Harris et al, Hum Dev, 2016
2. Te Pas et al, Pediatrics, 2007
3. Lista et al, Pediatrics, 2014

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