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

Qaasim Mian, Po Yin Cheung, Megan O'Reilly, Samantha K. Barton, Graeme R. Polglase, Georg M. Schmölzer

Research output: Contribution to journalArticleResearchpeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)F57-F62
Number of pages6
JournalArchives of Disease in Childhood: Fetal and Neonatal Edition
Volume104
Issue number1
DOIs
Publication statusPublished - 1 Jan 2019

Keywords

  • brain injury
  • delivery room
  • infants
  • neonatal resuscitation
  • newborn
  • respiratory functions tests

Cite this

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title = "Impact of delivered tidal volume on the occurrence of intraventricular haemorrhage in preterm infants during positive pressure ventilation in the delivery room",
abstract = "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.",
keywords = "brain injury, delivery room, infants, neonatal resuscitation, newborn, respiratory functions tests",
author = "Qaasim Mian and Cheung, {Po Yin} and Megan O'Reilly and Barton, {Samantha K.} and Polglase, {Graeme R.} and Schm{\"o}lzer, {Georg M.}",
year = "2019",
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doi = "10.1136/archdischild-2017-313864",
language = "English",
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Impact of delivered tidal volume on the occurrence of intraventricular haemorrhage in preterm infants during positive pressure ventilation in the delivery room. / Mian, Qaasim; Cheung, Po Yin; O'Reilly, Megan; Barton, Samantha K.; Polglase, Graeme R.; Schmölzer, Georg M.

In: Archives of Disease in Childhood: Fetal and Neonatal Edition, Vol. 104, No. 1, 01.01.2019, p. F57-F62.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Impact of delivered tidal volume on the occurrence of intraventricular haemorrhage in preterm infants during positive pressure ventilation in the delivery room

AU - Mian, Qaasim

AU - Cheung, Po Yin

AU - O'Reilly, Megan

AU - Barton, Samantha K.

AU - Polglase, Graeme R.

AU - Schmölzer, Georg M.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - brain injury

KW - delivery room

KW - infants

KW - neonatal resuscitation

KW - newborn

KW - respiratory functions tests

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U2 - 10.1136/archdischild-2017-313864

DO - 10.1136/archdischild-2017-313864

M3 - Article

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JO - Archives of Disease in Childhood: Fetal and Neonatal Edition

JF - Archives of Disease in Childhood: Fetal and Neonatal Edition

SN - 1359-2998

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