Pas, A.B. de
Citation
Pas, A. B. de. (2009, March 5). Spontaneous breathing and respiratory support of preterm infants at birth. Retrieved from
https://hdl.handle.net/1887/13595
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License: Licence agreement concerning inclusion of doctoral thesis in the Institutional Repository of the University of Leiden
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Note: To cite this publication please use the final published version (if applicable).
Ventilation of preterm infants in the delivery room
Arjan B te Pas, Frans J. Walther
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Based on: te Pas AB, Walther FJ. Ventilation of the preterm neonate in the delivery room.
Current Pediatric Reviews 2006 Aug; 2(3):187-97
Abstract
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Introduction
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d[i]Zeddah^oZViiZgb!gZhjaiZY^c8E6E[V^ajgZVcYi]ZeZgXZcid[hZXgZiZYhVijgViZY
e]dhe]Vi^YnaX]da^cZlVh]^\]ZgV[iZg']djghd[8E6Ei]VcV[iZg+]djgh!hj\\Zhi^c\i]Vi
hZXgZidgnhi^bja^VgZbVm^bVaV[iZgegZiZgbW^gi]VcYVXi^kVi^dcd[gZXnXa^c\VcYXViVWda^X
eVi]lVnh ^h YZaVnZY &+& # GVe^Y X]Vc\Zh ^c hjg[VXiVci eddah _jhi WZ[dgZ VcY V[iZg W^gi]
]VkZWZZcgZedgiZY &+'0&+( #>cVegZiZgbgVWW^ibdYZakZci^aViZY[gdbW^gi]!i]ZYdhZ"
gZhedchZd[Zmd\Zcdjhhjg[VXiVci^hYZXgZVhZYV[iZgYZaVnZYVYb^c^higVi^dcV[iZgkZci^aV"
i^dcViW^gi] &+) #
I]ZY^hVYkVciV\Zd[egde]naVXi^Xhjg[VXiVciigZVibZcid[gZhe^gVidgnY^higZhh^ci]ZYZa^kZgn
gddb^hejii^c\bVcn^c[Vcih!l]dldjaYc¼iYZkZadeG9H!Vig^h`[dgi]ZediZci^Va]VoVgYh
d[^cijWVi^dc &+*0&++ #Hnbeidbhd[gZhe^gVidgnY^higZhhViW^gi]^cegZiZgb^c[VcihbVn
cdiWZYjZidG9H!WjiYjZidi]Z^gZ[[dgihidXaZVgÅj^Y[gdbi]Z^gajc\h#:Vgan8E6EV^Yh
ajc\ZmeVch^dcVcYÅj^YXaZVgVcXZVcYVahdVaadlhi^bZidY^[[ZgZci^ViZWZilZZcG9HVcY
igVch^i^dcegdWaZbh#
Conclusion
8jggZci\j^YZa^cZhd[kZci^aVi^dcd[egZiZgb^c[VcihViW^gi]VgZWVhZYdca^b^iZYYViVVcY
i]ZXdbbdcegVXi^XZd[^cijWVi^c\VcYkZci^aVi^c\egZiZgb^c[Vcih^hcdiWVhZYdcYViV
dWiV^cZY [gdb egdheZXi^kZ! gVcYdb^oZY ig^Vah# I]Z a^b^iZY YViV gZÅZXi i]Z Y^[ÄXjai^Zh d[
eZg[dgb^c\hijY^Zh^c^c[VcihViW^gi]VcYbdgZlZaa"YZh^\cZYig^Vaha^`Zi]Z8D>C"ig^VaVgZ
cZZYZY#I]Zajc\hd[egZiZgb^c[VcihVgZkZgnkjacZgVWaZid^c_jgnXVjhZYWn^cijWVi^dcVcY
kZci^aVi^dc!ZheZX^VaanY^gZXianV[iZgW^gi]!VcYi]ZhZbdYVa^i^Zhh]djaYWZVkd^YZYl]ZcZkZg
edhh^WaZ#>cVeegdeg^ViZkZci^aVidghjeedgiYjg^c\gZhjhX^iVi^dcXVcegdkd`Zajc\YVbV\Z
kZgnZVh^an#;jijgZ^ckZhi^\Vi^dch]djaY[dXjhdci]ZWZhihigViZ\niddeZcjei]Zajc\VcY
b^c^b^oZajc\^c_jgn^cVegZiZgb^c[Vci#Jci^ai]Zci]Z[daadl^c\gZXdbbZcYVi^dch[dg
kZci^aVi^dcd[i]ZegZiZgb^c[VciViW^gi]VgZZmigVedaViZY[gdbVc^bVaYViV!dWhZgkVi^dcVa
hijY^Zh!]^hidg^XVaXd]dgiYViVVcYV[ZlgVcYdb^oZYXdcigdaaZYig^Vah#
&# Edh^i^kZegZhhjgZkZci^aVi^dcl^i]VE>Ed['%"'*Xb='D^hVYk^hZY^cegZiZgb^c[Vcih
VcY^c^i^Vaan]^\]ZgegZhhjgZhbVnWZcZZYZY#>YZVaani]ZegZhhjgZh]djaYWZVY_jhiZY
idVbZVhjgZYi^YVakdajbZ#
'# 6 hjhiV^cZY ^c^i^Va ^cÅVi^dc hZZbh id WZ VYkVciV\Zdjh [dg e]nh^dad\^XVa gZVhdch VcY
V\ddYVaiZgcVi^kZ[dgjh^c\^c^i^Vaan]^\]ZgegZhhjgZh#8gZVi^c\VcZVgan;G8l^i]i]^h
iZX]c^fjZbVngZYjXZi]ZcZZY[dg^cijWVi^dc#
(# E::EYjg^c\gZhjhX^iVi^dc^hcZXZhhVgnid`ZZei]Zajc\deZcVcYXgZViZVcVYZfjViZ
;G8# E::E aZkZah je id - Xb ='D h]djaY WZ Xdch^YZgZY [dg gZhjhX^iVi^dc d[ egZiZgb
^c[Vcih#
)# 6egZhhjgZa^b^iZYI"e^ZXZkZci^aVidg Z#\#CZdej[[ ^hi]ZWZhiVcYZVh^ZhilVnidYZa^kZg
VXdch^hiZciVcYhjhiV^cZYE>EVcYVYZfjViZE::E aZkZad[Zk^YZcXZ+ #>i^hi]Zdcan
YZk^XZl]^X]XVc\^kZ8E6E^bbZY^ViZanV[iZgkZci^aVi^dc#
*# L]Zcjh^c\V[VXZbVh`Yjg^c\edh^i^kZegZhhjgZkZci^aVi^dc!dcZh]djaYWZVlVgZi]Vi
aZV`V\ZdXXjghVcYXVcaZVYid^chj[ÄX^ZcikZci^aVi^dc#I]^hbVnWZVkd^YZYWnjh^c\
cVhVaegdc\hVh^ciZg[VXZ#
+# 6lV^i^c\ [jgi]Zg Xa^c^XVa ig^Vah! gZhjhX^iVi^dc hiVgi^c\ l^i] &%% dmn\Zc ^h hi^aa gZXdb"
bZcYZY^cegZiZgb^c[Vcih#I]ZgZ^hVc^cXgZVh^c\XdcXZgcVWdji]neZgdm^Xajc\^c_jgn!
l]^X]XVcWZVYYgZhhZYWnlZVc^c\Ydlci]Zdmn\ZcXdcXZcigVi^dcVhfj^X`anVhXa^c^"
XVaanedhh^WaZ#
,# :Vgan8E6EXVcWZjhZYVh^c^i^VaigZVibZci[dgkZgnegZiZgb^c[Vcih#IdegZkZciXdaaVehZ
d[i]Zajc\i]^hh]djaYWZhiVgiZYY^gZXian^ci]ZYZa^kZgngddb#
-# Hjg[VXiVcih]djaYWZVYb^c^hiZgZYZVgan!^#Z#VhhddcVhi]ZegZiZgb^c[Vci^h^cijWViZY
[dgG9H#Egde]naVXi^Xhjg[VXiVci^ci]ZYZa^kZgngddbXdjaYaZVYiddkZgigZVibZciVcY
h]djaYWZVkd^YZY#
LZ gZXZcian hiVgiZY V gVcYdb^oZY XdcigdaaZY ig^Va :;JG8>"ig^Va! :Vgan ;jcXi^dcVa GZh^YjVa
8VeVX^in>ciZgkZci^dc id^ckZhi^\ViZl]Zi]ZghjhiV^cZY^cÅVi^dcl^i]VbZX]Vc^XVaYZk^XZ
CZdej[[ VcYZVgancVhVaXdci^cjdjhedh^i^kZV^glVnegZhhjgZ ;^\jgZ& l^aaWZVbdgZ
Z[[ZXi^kZbVcV\ZbZcihigViZ\n^cegZiZgb^c[Vcihi]VcXdckZci^dcVa^ciZgkZci^dc ;^\jgZ
' VcY l^aa gZYjXZ i]Z gZfj^gZbZci [dg bZX]Vc^XVa kZci^aVi^dc VcY hjg[VXiVci igZVibZci#
7di]gZ\^bZchVgZYZe^XiZY^c;^\jgZh&VcY'Vhi]ZnegdWVWanegZhZcii]ZXjggZciX]d^XZh
d[kZci^aVi^dchigViZ\^Zh[dgegZiZgb^c[VcihViW^gi]#
6[iZg i]^gY e]VhZ/ ^[ ]ZVgi gViZ1 +%$b^c V[iZg edh^i^kZ egZhhjgZ kZci^aVi^dc! hiVgi i]dgVm XdbegZhh^dc VcY
Xdch^YZgZe^cZe]g^cZ0
HedciVcZdjhWgZVi]^c\l^i]/\ddYX]ZhibdkZbZcih!h`^cXdadjgVcY]ZVgigViZ3&%%$b^c4
N:H2sufficient!CD2insufficient!\ddYh`^cXdadjgVcY]ZVgi3&%%$b^c!WjiVecZVdgYnhecZV2improve- ment, but insufficient.
HiVgil^i];^D'&#%VcYlZVcYdlcVhhddcVhedhh^WaZ!YZeZcY^c\dch`^cXdadjgVcY]ZVgigViZ#
1030sec Sufficientspontaneous
breathing(**)
Noorinsufficientspontaneous
breathing(**)
3045sec sufficient
Noorinsufficientspontaneous
breathing
4560sec
(*)
Noorinsufficientspontaneous improvement,
Breathing butinsufficient(**)
6090sec
(510min)
insufficient
Drying,preventheatloss
Positioning
Oropharyngealsuctioning Oxygen
Observe
Observe
Staysadequate
TransfertoNICU
Insertionofanasopharyngealtube
Firstsustainedinflationfor10secondswith
Neopuffdevice;PIP20cmH2O,FiO21.0
(***)(mouthandnostrilclosed)
PEEPafterinflation;56cmH2O
ContinueCPAP
at56cmH2O
TransfertoNICU
Secondsustainedinflationfor10seconds
withNeopuffdevice;PIP25cmH2O,FiO21.0
(***)
PEEP after inflation; 56 cmH2O
Endotracheal
intubationandIPPVTi
0.3sec,60min 1,PIP
20cmH2O,PEEP46
cmH2O
NasalIPPVupto5
minwithNeopuff
device(Ti0.5sec,
60/min,PIP2025
cmH2O)
Figure 1#:;JG8> :Vgan;jcXi^dcVaGZh^YjVa8VeVX^in>ciZgkZci^dc #
6[iZghZXdcYe]VhZ/^[]ZVgigViZ1+%$b^cV[iZgedh^i^kZegZhhjgZkZci^aVi^dc!hiVgii]dgVmXdbegZhh^dcVcY
Xdch^YZgZe^cZe]g^cZ
HiVgil^i];^D'&#%VcYlZVcYdlcVhhddcVhedhh^WaZ!YZeZcY^c\dch`^cXdadjgVcY]ZVgigViZ#
8E6E^hhiVgiZYdci]ZC>8JYZeZcY^c\dci]ZXa^c^XVa_jY\bZcid[i]ZcZdcVidad\^hiVcYhZkZg^ind[G9H#
030sec
Sufficient
3060sec (*)
Sufficient
Insufficient 6090sec
Drying,positioning
Oropharyngeal
suctioningO2
Observe
Staysadequate
TransfertoNICU
PPVwithselfinflating
bagandmaskduring30
seconds,firstinflations
Pmax=35cmH2O,PEEP
5cmH2O,laterPmax=
20cmH2O,FiO21.0(**)
Observe
Staysadequate
TransfertoNICU
O2ifnecessary
(***)
Endotracheal
intubationandIPPVTi
0.3sec,60min 1,PIP
20cmH2O,PEEP46
cmH2O
Figure 2#8dckZci^dcVa^ciZgkZci^dcd[egZiZgb^c[Vci
Reference List
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Z.,-"Z.--#
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i^dc#GZhjhX^iVi^dc&..-0(, ' /&%("&&%#
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8dbb^iiZZdcGZhjhX^iVi^dc#8^gXjaVi^dc'%%%0&%' -Hjeea />()(">(*,#
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