New Strategies of Pulmonary Protection of Preterm Infants in DR with the RFM

In this study, the authors set out to analyze if the use of a respiratory function monitor (RFM) during the initial breaths can improve lung stabilization and prevent the use of large tidal volumes (Vt) in the delivery room (DR). 

This randomized clinical trial conducted in a tertiary perinatal center where 167 newborns were eligible, out of which 106 (52 in RFM masked group and 54 in RFM visible group) had respiratory function data available for analysis. Pulmonary data were recorded during the first 10 minutes after birth. Substantial mask leak was observed during all breath types with predominance during insufflations and in the RFM masked group. 

It was found that median expiratory Vts during inflations were greater in the masked group (7mL/kg) than in the visible group (5.8 mL/kg; p=0.001) same as peak inflation pressure (PIP) administered (21.5 vs 19.7 cmH₂O; p<0.001). Consequently minute volumes were greater in the masked group (256 vs 214 mL/kg/min; p<0.001), with no differences in respiratory rate. 

These differences were higher in those <30 weeks’ gestational age (GA). There was no difference in the need of surfactant administration or intubation during the first 72 hours of age. 

Conclusion

In conclusion, the authors state that using a RFM in the DR prevents the use of large Vt and PIP during respiratory support inflations, mostly in the more immature newborn infants, but with no other short-term benefits. 

The authors recognise that the potential of RFM is not only limited to detect and manage problems associated with mask ventilation in the DR, such as facemask leaks and obstructions, but even more importantly measuring the unknown and highly variable Vt than an infant receives when operators rely on clinical signs to guide support.