The American Academy of Paediatrics formulated the Neonatal
resuscitation guidelines and published it in 2010 and suggested
modification based on local needs1 .These guidelines primarily apply to
neonates undergoing transition from intrauterine to extrauterine life with
difficulty. About 1 in 10 neonates require some form of resuscitation and
fewer than 1% require extensive resuscitation 2.
Ventilation of the lungs is the most important step for successful
resuscitation. Ineffective ventilation is an important cause of prolonged or
unsuccessful resuscitation. Effective resuscitation needs proper
anticipation, adequate preparation, accurate evaluation and prompt
initiation. The first minute of neonatal resuscitation is known as the
golden minute where active steps are taken to ventilate the newborn
lungs.
Each step in resuscitation is performed for 30 seconds along with
assessment of heart rate, respiration and oxygen saturation at the end of
every step. The decision to administer positive pressure ventilation
(PPV) is taken at the end of 30 seconds of starting resuscitation when the
neonate is apneic or gasping or with heart rate less than 100/min.
1. Use of T piece resuscitator resulted in higher number of neonates
achieving a Heart rate _ 100/min at 2 minutes of age when
compared to self inflating bag and self inflating bag with PEEP
valve. Hence T piece resuscitator seems to be more effective than
self inflating bag and self inflating bag with PEEP valve in delivery
room newborn resuscitation of babies more than 28 weeks
gestation. This was statistically insignificant. A larger sample size
may be needed to clearly demonstrate the advantage of T piece
resuscitator over self inflating bag and self inflating bag with PEEP
valve.
2. Resuscitation with T piece resuscitator achieves a Heart rate _ 100
at a significantly lesser time than self inflating bag and self
inflating bag with PEEP valve .
3. T piece resuscitator and self inflating bag with PEEP valve enables
a newborn to achieve significantly higher oxygen saturation at 5
minutes of age than self inflating bag. The effect is more
pronounced in more than 34 weeks gestational age.
4. T piece reduces the number of babies requiring delivery room
intubation, chest compressions and medications compared to self
inflating bag and self inflating bag with PEEP valve though
statistically insignificant.
5. T piece resuscitator reduces the number of babies requiring
invasive ventilation but the effect is not significant statistically.
6. There is no difference in complications like air leaks between the
three devices.
7. Provision of PEEP by T piece resuscitator or self inflating bag with
PEEP valve improves the short term outcomes in neonatal
resuscitation but requires further adequately powered studies with
higher sample size to test for statistical significance if any.
8. In settings where T piece resuscitator may not be available use of
self inflating bag with PEEP valve could be an alternative
resuscitation device in newborn resuscitation
