Unraveling the Links Between the Initiation of Ventilation and Brain Injury in Preterm Infants

Unraveling the Links Between the Initiation of Ventilation and Brain Injury in Preterm Infants

Inappropriate tidal volumes (VT) delivered to preterm infants during respiratory support substantially increase the risk of injury and inflammation to the lungs and brain. This is of particular importance given that preterm infants have a significantly increased risk of acute and chronic brain injury compared to term infants. 

Given the higher incidence of poor neurodevelopmental outcomes in preterm infants, reducing the incidence and severity of brain injury in this population is essential to enhance the long-term health and welfare of individuals born preterm.

In the neonatal intensive care unit (NICU), neonatologists are careful to apply mechanical ventilation strategies that are gentle and minimise trauma to the lungs, yet the same gentle approach to reduce ventilator-induced lung injury (VILI) have not been employed in the delivery room. 

The authors point out, that monitoring of both PIP and VT during ventilation in the DR would aid clinicians in accurate placement of face mask (reducing mask leak) and repositioning head and neck in case of airway obstruction, thus optimizing ventilation and preventing delivery of excessive VTs.  


Many preterm infants require intermittent positive pressure ventilation (IPPV) in the delivery room. Due to the lack of sophistication of devices used to provide respiratory support to preterm infants in the delivery room, many of these babies receive inadvertently high VT, which can injure their immature lungs and brain. 

The safety and effectiveness of mask ventilation may be improved if respiratory function monitoring is used to help clinicians deliver appropriate VTs. Non-invasive respiratory support in the delivery room reduces the risks associated with endotracheal intubation.