Impact of delivered tidal volume on the occurrence of intraventricular haemorrhage in preterm infants during positive pressure ventilation in the delivery room

Background and objectives Delivery of inadvertent high tidal volume (V T) during positive pressure ventilation (PPV) in the delivery room is common. High V T delivery during PPV has been associated with haemodynamic brain injury in animal models. We examined if V T delivery during PPV at birth is associated with brain injury in preterm infants <29 weeks' gestation. Methods A flow-sensor was placed between the mask and the ventilation device. V T values were compared with recently described reference ranges for V T in spontaneously breathing preterm infants at birth. Infants were divided into two groups: V T <6mL/kg or V T >6 mL/kg (normal and high V T, respectively). Brain injury (eg, intraventricular haemorrhage (IVH)) was assessed using routine ultrasound imaging within the first days after birth. Results A total of 165 preterm infants were included, 124 (75%) had high V T and 41 (25%) normal V T. The mean (SD) gestational age and birth weight in high and normal V T group was similar, 26 (2) and 26 (1) weeks, 858 (251) g and 915 (250) g, respectively. IVH in the high V T group was diagnosed in 63 (51%) infants compared with 5 (13%) infants in the normal V T group (P=0.008). Severe IVH (grade III or IV) developed in 33/124 (27%) infants in the high V T group and 2/41 (6%) in the normal V T group (P=0.01). Conclusions High V T delivery during mask PPV at birth was associated with brain injury. Strategies to limit V T delivery during mask PPV should be used to prevent high V T delivery.