The white paper “Improving ventilation performance at birth” presents important scientific findings in the field of neonatal transition at birth.
Despite being one of the most important interventions taking place in the delivery room, 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 has, however, been shown not to be the easiest thing. There is growing evidence that ventilation performance can be substantially improved if the caregiver has easy access to more ventilation 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 over-ventilation. Brain damage caused by high Vt has previously been shown in several animal studies. Recently it was shown also in human preterm babies that high Vt is associated with a higher incidence of intraventricular haemorrhage. The same paper points out that strategies to limit the delivery of high Vt during mask ventilation is needed.
There is indeed a fine line between under-ventilation and over-ventilation leading to volutrauma, and efficient resuscitation procedures have been identified as a major opportunity for improvement in the clinical care of newborns.