Efficacy of FiO2 Increase During the Initial Resuscitation of Premature Infants < 29 Weeks: An Observational Study

To evaluate the heart rate (HR) and oxygen saturation (SpO2) at 15-second intervals within 60 seconds after incremental increases of fractional inspired oxygen (FiO2) during resuscitation of infants younger than 29 weeks requiring two different forms of ventilatory support. Study design: Retrospective observational study. Methods: Forty-three infants were stabilized, 14 by continuous positive airway pressure exclusively (CPAP group), and 29 by positive pressure ventilation (PPV group). Both groups received ventilatory support in a special bed with two cameras enabling the evaluation of all interventions including HR, SpO2, FiO2, positive inflation pressure, and positive end-expiratory pressure values. FiO2 was commenced at 0.30 and titrated in 0.1–0.2 increments every 30–60 seconds. The relationships between the incremental increases of FiO2 and related SpO2 and HR changes were evaluated. Results: Although there was an inverse correlation between initial FiO2 and SpO2 in both groups, a significant positive correlation between the incremental increase of FiO2 and SpO2 changes after 30 seconds was found only in the CPAP group. Only higher initial levels of FiO2 had a positive effect on the improvement in SpO2 in the PPV group. Conclusion: The efficacy of FiO2 titration in 0.1–0.2 increments may be attenuated and delayed in extremely preterm infants required PPV during the first 6 minutes of life

Reflexes that impact spontaneous breathing of preterm infants at birth: a narrative review

Some neural circuits within infants are not fully developed at birth, especially in preterm infants. Therefore, it is unclear whether reflexes that affect breathing may or may not be activated during the neonatal stabilisation at birth. Both sensory reflexes (eg, tactile stimulation) and non-invasive ventilation (NIV) can promote spontaneous breathing at birth, but the application of NIV can also compromise breathing by inducing facial reflexes that inhibit spontaneous breathing. Applying an interface could provoke the trigeminocardiac reflex (TCR) by stimulating the trigeminal nerve resulting in apnoea and a reduction in heart rate. Similarly, airflow within the nasopharynx can elicit the TCR and/or laryngeal chemoreflex (LCR), resulting in glottal closure and ineffective ventilation, whereas providing pressure via inflations could stimulate multiple receptors that affect breathing. Stimulating the fast adapting pulmonary receptors may activate Head's paradoxical reflex to stimulate spontaneous breathing. In contrast, stimulating the slow adapting pulmonary receptors or laryngeal receptors could induce the Hering-Breuer inflation reflex or LCR, respectively, and thereby inhibit spontaneous breathing. As clinicians are most often unaware that starting primary care might affect the breathing they intend to support, this narrative review summarises the currently available evidence on (vagally mediated) reflexes that might promote or inhibit spontaneous breathing at birth.Developmen

The effect of a face mask for respiratory support on breathing in preterm infants at birth

Development and application of statistical models for medical scientific researc

Intervention et rôle du pédiatre en salle de naissance

International audienceSome newborns require the presence of a paediatrician in the delivery room, for emergency care. This generally leads to hospitalisation in neonatal intensive care or neonatology. Prematurity and respiratory distress are the main causes. These unexpected situations are a source of anxiety for the parents. It is essential that the multidisciplinary team draws on both its technical and relational expertise, in order to provide optimal treatment to the infant while supporting the parents with the necessary empathy.Certains nouveau-nés nécessitent la présence d’un pédiatre en salle de naissance, pour uneprise en charge en urgence. Celle-ci conduit généralement à une hospitalisation en réanimationnéonatale ou en néonatologie. La prématurité et les détresses respiratoires en sont les principalescauses. Ces situations non attendues sont source d’angoisse pour les parents. Il est fondamentalque l’équipe pluriprofessionnelle fasse preuve d’une expertise à la fois technique et relationnelle,afin de prendre en charge l’enfant de façon optimale et d’accompagner les parents avec l’empathienécessaire