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About 3 to 6 % of newborns require manual ventilation support to start breathing. Both under- and overventilation can seriously damage lungs and brain. Although it is one of the least controlled interventions taking place in the delivery room, the healthcare personnel are lacking good tools to evaluate how effective the treatment is.

At the neonatal intensive care unit, babies are carefully supervised. Often they are connected to highly specialized ventilators where ventilation related parameters are carefully measured, monitored and adjusted. Usually, care of the newborn is, however, initiated already in the delivery room where the first emergency procedures are performed. Despite being one of the most important interventions taking place there, manual ventilation is one of the least controlled. The tidal volumes (VT) given during neonatal transition are rarely monitored and it is up to the caregiver to estimate the volumes given trusting his or her clinical experience.

The standard technique for manual ventilation with positive pressure is regulating breath size through the amount of pressure applied. The goal is to deliver an appropriate VT and to establish a functional residual capacity. This is, however, easier said than done. There is growing evidence that ventilation performance can be substantially improved if the caregiver has easy access to more ventilation related parameters such as actual VT delivered and face mask leak, and not only peak inspiratory pressure.

It is well-known that underventilation can lead to increased morbidity – but so can overventilation. Delivering too high VT during manual ventilation can cause irreparable lung damage and as a consequence of the initiation of an inflammatory response in the lungs, also brain damage. Moreover, too high VT may also lead to intraventricular haemorrhage.

Efficient resuscitation procedures have been identified as a major opportunity for improvement in the clinical care of newborns.