Enhanced monitoring during neonatal resuscitation

Adequate ventilation is the cornerstone of successful neonatal resuscitation, therefore it is mandatory that anybody involved in neonatal resuscitation is trained in mask ventilation techniques. In this article, the authors discuss the currently available monitoring devices used during stabilization/resuscitation in the delivery room (DR).

Ventilator monitors are routinely used in the neonatal intensive care unit (NICU) to guide effectiveness of ventilation and would be very useful during resuscitation. In the DR, mask PPV is guided by subjective clinical assessment. 

Using respiratory function monitoring in the DR enables the caregiver to measure a number of parameters including continuous positive airway pressure (CPAP), respiratory rate (RR), tidal volume (VT), expiratory minute ventilation, and leak between mask and face or around an endotracheal tube (ET). 

The authors point out that the use of RFM during neonatal resuscitation has been shown in several studies to reduce mask leak, minimize the variation in VT, assist with determining whether an ET has been properly inserted in the trachea or has become displaced and indicate airway obstruction. 

Schmölzer et al reflect upon the fact that increased data points (e.g. from RFMs) might introduce additional attentional and cognitive demands on healthcare professionals (HCPs). 

Conclusion

The authors conclude that…’The major challenge to neonatal resuscitation in the DR is the lack of direct feedback about the effectiveness of the interventions that are employed. Monitoring of key variables such as heart rate, oxygen saturation, temperature, and respiratory function allows the resuscitator to identify problems and adjust technique in order to improve outcomes for newborns.