A multi-centre randomised controlled trial of respiratory function monitoring during stabilisation of very preterm infants at birth.

Aim: To determine whether the use of a respiratory function monitor (RFM) during PPV of extremely preterm infants at birth, compared with no RFM, leads to an increase in percentage of inflations with an expiratory tidal volume (Vte) within a predefined target range.

Methods: Unmasked, randomised clinical trial conducted October 2013 - May 2019 in 7 neonatal intensive care units in 6 countries. Very preterm infants (24-27 weeks of gestation) receiving PPV at birth were randomised to have a RFM screen visible or not.

Delivery Room Management of Infants with Very Low Birth Weight in 3 European Countries-The Video Apgar Study.

Objective: To assess delivery room management of infants born preterm at 4 Level III perinatal centers in 3 European countries.

Study Design: This was a prospective, multicenter observational study. Management at birth was video-recorded and evaluated (Interact version 9.

Neonatal Safety of Elective Family-Centered Caesarean Sections: A Cohort Study.

Background: Although little data are available concerning safety for newborns, family-centered caesarean sections (FCS) are increasingly implemented. With FCS mothers can see the delivery of their baby, followed by direct skin-to-skin contact. We evaluated the safety for newborns born with FCS in the Leiden University Medical Center (LUMC), where FCS was implemented in June 2014 for singleton pregnancies with a gestational age (GA) ≥38 weeks and without increased risks for respiratory morbidity.

The Breathing Effort of Very Preterm Infants at Birth.

Objective: To compare the respiratory effort of very preterm infants receiving positive pressure ventilation (PPV) with infants breathing on continuous positive airway pressure (CPAP), directly after birth.

Study Design: Recorded resuscitations of very preterm infants receiving PPV or CPAP after birth were analyzed retrospectively. The respiratory effort (minute volume and recruitment breaths [>8 mL/kg], heart rate, oxygen saturation, and oxygen requirement were analyzed for the first 2 minutes and in the fifth minute after birth.

The effect of breathing on ductus arteriosus blood flow directly after birth.

Unlabelled: Spontaneous breathing at birth influences ductus arteriosus (DA) flow. This study quantifies the effect of breathing on DA shunting directly after birth. In healthy term infants born by elective cesarean section, simultaneous measurements of DA shunting and tidal volumes during spontaneous breathing were performed at 2-5, 5-8, and 10-13 min after birth.

Herpes simplex transmission to chest and face through autoinoculation in an infant.

A 4-month-old female infant presented with a vesicular lesion on her left hand present since 1 day. A few days prior to presentation, she had a similar lesion on the lower lip. Two days after presentation, she returned with new lesions on her thorax and upper eyelid.

Caffeine to improve breathing effort of preterm infants at birth: a randomized controlled trial.

BackgroundCaffeine promotes spontaneous breathing by antagonizing adenosine. We assessed the direct effect of caffeine on respiratory effort in preterm infants at birth.MethodsThirty infants of 24-30 weeks of gestation were randomized for receiving caffeine directly after birth in the delivery room (caffeine DR group) or later in the neonatal intensive care unit (control group).

Effect of body position and ventilation on umbilical artery and venous blood flows during delayed umbilical cord clamping in preterm lambs.

Objective: While delayed umbilical cord clamping (UCC) is thought to facilitate placental to infant blood transfusion, the physiological factors regulating flow in the umbilical arteries and veins during delayed UCC is unknown. We investigated the effects of gravity, by changing fetal height relative to the placenta, and ventilation on umbilical blood flows and the cardiovascular transition during delayed UCC at birth.

Methods: Catheters and flow probes were implanted into preterm lambs (128 days) prior to delivery to measure pulmonary, carotid, umbilical artery (UaBF) and umbilical venous (UvBF) blood flows.

Accuracy of currently available neonatal respiratory function monitors for neonatal resuscitation.

Unlabelled: This study aimed to test the accuracy in volume measurements of three available respiratory function monitors (RFMs) for neonatal resuscitation and the effect of changing gas conditions. The Florian, New Life Box Neo-RSD (NLB Neo-RSD) and NICO RFM were tested on accuracy with volumes of 10 and 20 mL and on changes in volume measurements under changing gas conditions (oxygen level 21-100 % and from cold dry air (24 ± 2 °C) to heated humidified air (37 °C). Volume differences >10 % were considered clinically relevant.

Cardiorespiratory Monitoring during Neonatal Resuscitation for Direct Feedback and Audit.

Neonatal resuscitation is one of the most frequently performed procedures, and it is often successful if the ventilation applied is adequate. Over the last decade, interest in seeking objectivity in evaluating the infant's condition at birth or the adequacy and effect of the interventions applied has markedly increased. Clinical parameters such as heart rate, color, and chest excursions are difficult to interpret and can be very subjective and subtle.

The cardiovascular response to birth asphyxia is altered by the surrounding environment.

Background: A sustained bradycardia is used as a major indicator of severe perinatal asphyxia. However, lambs asphyxiated ex utero do not exhibit the same bradycardic response as lambs asphyxiated in utero. It is possible that the local in utero environment may influence the initial cardiovascular response to asphyxia.

A randomised trial of placing preterm infants on their back or left side after birth.

Background: Basic life support guidelines recommend placing spontaneously breathing children and adults on their side. Though the majority of preterm newborns breathe spontaneously, they are routinely placed on their back after birth. We hypothesised that they would breathe more effectively when placed on their side.

The perfusion index of healthy term infants during transition at birth.

Unlabelled: Perfusion index is a continuous parameter provided by pulse oximetry and might be useful for evaluating hemodynamic changes at birth and identifying transitional problems. The objective was to describe perfusion index values in term infants immediately after birth. Perfusion index of 71 healthy term born infants were recorded during the first 10 min after birth, using a pulse oximetry sensor placed preductally.

Effectivity of ventilation by measuring expired CO2 and RIP during stabilisation of preterm infants at birth.

Objective: To measure tidal volume, plethysmography changes and gas exchange during respiratory support at birth.

Design: The following parameters were measured: (1) expired tidal volumes (Vte (mL/kg)) using respiratory function monitoring, (2) changes in plethysmography (AU/kg) per breath using respiratory inductance plethysmography (bands placed around rib cage (RC) and abdomen (AB)) and (3) expired CO2 (ECO2) levels using a volumetric CO2 monitor. For respiratory support, a T-piece resuscitator and facemask were used with peak inspiratory pressure (PIP) 25 cm H2O and positive end expiratory pressure 5 cm H2O.

Very Preterm Infants Failing CPAP Show Signs of Fatigue Immediately after Birth.

Objective: To investigate the differences in breathing pattern and effort in infants at birth who failed or succeeded on continuous positive airway pressure (CPAP) during the first 48 hours after birth.

Methods: Respiratory function recordings of 32 preterm infants were reviewed of which 15 infants with a gestational age of 28.6 (0.

The first breaths of life: imaging studies of the human infant during neonatal transition.

The neonatal transition during birth is characterized by major physiological changes in respiratory and hemodynamic function, which are predominantly initiated by labor, lung aeration and clamping of the umbilical cord. Lung liquid clearance and lung aeration are not only important for the establishment of functional residual capacity, but these events also trigger the significant decrease in pulmonary vascular resistance and increase in pulmonary blood flow. Clamping the umbilical cord also contributes to these hemodynamic changes by increasing the systemic vascular resistance and sudden loss of a large proportion of venous return.

Mask versus Nasal Tube for Stabilization of Preterm Infants at Birth: Respiratory Function Measurements.

Objective: To compare the nasal tube with face mask as interfaces for stabilization of very preterm infants at birth by using physiological measurements of leak, obstruction, and expired tidal volumes during positive pressure ventilation (PPV).

Study Design: In the delivery room, 43 infants <30 weeks gestation were allocated to receive respiratory support by nasal tube or face mask. Respiratory function, heart rate, and oxygen saturation were measured.

Cardiovascular transition at birth: a physiological sequence.

The transition to newborn life at birth involves major cardiovascular changes that are triggered by lung aeration. These include a large increase in pulmonary blood flow (PBF), which is required for pulmonary gas exchange and to replace umbilical venous return as the source of preload for the left heart. Clamping the umbilical cord before PBF increases reduces venous return and preload for the left heart and thereby reduces cardiac output.

The influence of crying on the ductus arteriosus shunt and left ventricular output at birth.

Background: During neonatal transition, ductus arteriosus (DA) flow changes from right-to-left to left-to-right and contributes considerably to the increase in pulmonary blood flow. Large transpulmonary pressures generated by crying at birth can influence the DA shunt.

Objective: This study aimed to assess differences in DA shunt during quiet breathing and crying directly after birth.

Pulse oximetry measures a lower heart rate at birth compared with electrocardiography.

Objective: To examine the effect of time after birth on heart rate (HR) measured by pulse oximetry (PO) (HRPO) and electrocardiography (ECG) (HRECG).

Study Design: HRECG and HRPO (collected at maximum sensitivity) were assessed in 53 term and preterm infants at birth. ECG electrodes and a PO sensor were attached as soon as possible and HRECG and HRPO were compared every 30 seconds from 1-10 minutes after birth.

Two-minute training for improving neonatal bag and mask ventilation.

Objectives: To test effectivity of a two-minute training consisting of a few key-points in ventilation using the self-inflating bag (SIB).

Study Design: Experienced and inexperienced caregivers were asked to mask ventilate a leak free manikin using the SIB before and after the training. Mask leak and pressures were measured using respiratory function monitoring.

Monitoring tidal volumes in preterm infants at birth: mask versus endotracheal ventilation.

Objective: Upper airway distention during mask ventilation could reduce gas volumes entering the lung compared with ventilation via an endotracheal tube. Therefore, respiratory tract volumes were measured in lambs and tidal volumes were compared in preterm infants before and after intubation.

Design: In seven preterm lambs, volumes of the airways (oropharynx, trachea, lungs) were assessed.

Effects of a sustained inflation in preterm infants at birth.

Objective: To assess the clinical effect of an initial sustained inflation of 10 seconds and 25 cmH2O in preterm infants at birth.

Study Design: In this observational study inflation pressures and tidal volumes were recorded with the use of respiratory function monitoring of preterm infants <32 weeks' gestation receiving a sustained inflation. Inspiratory tidal volume (Vti) and expiratory tidal volume (Vte) of sustained inflation and cumulative Vti and Vte of breaths during sustained inflation were determined.

Non-invasive measurements of ductus arteriosus flow directly after birth.

Objective: To assess ductus arteriosus (DA) blood flow directly after birth in healthy term infants after elective caesarean section.

Design: In healthy term newborns, echocardiography was performed at 2, 5 and 10 min after birth to monitor cardiac output and DA blood flow. Heart rate (HR) was assessed using ECG.

Accuracy of a disposable compared to a non-disposable infant T-piece resuscitator.

Unlabelled: Both disposable and non-disposable T-piece resuscitator (TPR) devices are used. Accuracy of the disposable and non-disposable infant TPR was compared. Peak inspiratory pressures (PIP) and positive end-expiratory pressures (PEEP) were measured during ventilation of a test lung.