Rescue nasopharyngeal tube for preterm infants non-responsive to initial ventilation after birth.
Pediatr Res
; 96(1): 141-147, 2024 Jul.
Article
en En
| MEDLINE
| ID: mdl-38273117
ABSTRACT
BACKGROUND:
Physiological changes during the insertion of a rescue nasopharyngeal tube (NPT) after birth are unclear.METHODS:
Observational study of very preterm infants in the delivery room. Data were extracted at predefined timepoints starting with first facemask placement after birth until 5 min after insertion of NPT. End-expiratory lung impedance (EELI), heart rate (HR) and SpO2/FiO2-ratio were analysed over time. Changes during the same time span of NIPPV via facemask and NIPPV via NPT were compared.RESULTS:
Overall, 1154 inflations in 15 infants were analysed. After NPT insertion, EELI increased significantly [0.33 AU/kg (0.19-0.57), p < 0.001]. Compared with the mask period, changes in EELI were not significantly larger during the NPT period [median difference (IQR) = 0.14 AU/kg (-0.14-0.53); p = 0.12]. Insertion of the NPT was associated with significant improvement in HR [52 (33-96); p = 0.001] and SpO2/FiO2-ratio [161 (69-169); p < 0.001] not observed during the mask period.CONCLUSIONS:
In very preterm infants non-responsive to initial facemask ventilation after birth, insertion of an NPT resulted in a considerable increase in EELI. This additional gain in lung volume was associated with an immediate improvement in clinical parameters. The use of a NPT may prevent intubation in selected non-responsive infants. IMPACT After birth, a nasopharyngeal tube may be considered as a rescue airway in newborn infants non-responsive to initial positive pressure ventilation via facemask. Although it is widely used among clinicians, its effect on lung volumes and physiological parameters remains unclear. Insertion of a rescue NPT resulted in a considerable increase in lung volume but this was not significantly larger than during facemask ventilation. However, insertion of a rescue NPT was associated with a significant and clinically important improvement in heart rate and oxygenation. This study highlights the importance of individual strategies in preterm resuscitation and introduces the NPT as a valid option.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Recien Nacido Prematuro
/
Nasofaringe
Tipo de estudio:
Observational_studies
Límite:
Female
/
Humans
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Male
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Newborn
Idioma:
En
Revista:
Pediatr Res
Año:
2024
Tipo del documento:
Article
País de afiliación:
Suiza