Crying and Breathing by Extremely Preterm Infants Immediately After Birth

doi:10.1016/j.jpeds.2010.01.007

The Journal of Pediatrics

Volume 156, Issue 5, May 2010, Pages 846-847

https://doi.org/10.1016/j.jpeds.2010.01.007 Get rights and content

We reviewed videos of 61 extremely preterm infants taken immediately after birth. The majority cried (69%) and breathed (80%) without intervention. Most preterm infants are not apneic at birth.

Section snippets

Methods

Since January 2004, we have studied infants who were anticipated to need resuscitation in the delivery rooms (DR) of the Royal Women's Hospital, Melbourne, Australia, with the permission of the Research and Ethics Committees.¹⁰ When available, a member of the investigating team recorded the care given to these infants immediately after birth with a high definition digital video camera. Sound was recorded at all deliveries. The investigator was not involved in the resuscitation. Immediately

Results

Of 156 videos recorded between January 2004 and October 2005, 61 were of eligible infants. The mean (SD) gestational age and weight at birth were 26 (2) weeks and 838 (192) g, respectively. All but 2 infants were exposed to antenatal corticosteroids.

Forty-two (69%) of these infants had an audible cry and visible breathing immediately after birth. A further 7 infants had visible breathing without crying, giving a total of 49 infants who breathed (80%) before any respiratory support was given.

Discussion

In some centers, all extremely preterm infants are intubated soon after birth for surfactant treatment regardless of whether or not they breathe. This was not the policy in our hospital; thus, whether to intubate a preterm infant was a clinical decision. Many infants in our study were intubated though they were breathing and had a heart rate >100 bpm on CPAP. In some cases, the clinicians thought that the infant was too immature to continue to breathe successfully on CPAP; in others, the reason

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Studies in animals have shown that vocal cords (VCs) close during apnoea before and after birth, thereby impairing the effect of non-invasive ventilation. We tested the feasibility of visualising VCs using ultrasonography (US) and investigated the position and movement of the VCs during non-invasive respiratory support of preterm infants at birth.
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Opportunities to learn and maintain competence in neonatal intubation have decreased. As many clinicians providing care to the newborn infant are not skilled in intubation, alternative strategies are critical. Most preterm infants breathe spontaneously, and require stabilisation rather than resuscitation at birth. Use of tactile stimulation, deferred cord clamping, and avoidance of hypoxia can help optimise breathing for these infants. Nasal devices appear a promising alternative to the face mask for early provision of respiratory support. In term and near-term infants, supraglottic airways may be the most effective initial approach to resuscitation. Use of supraglottic airways during resuscitation can be taught to a range of providers, and may reduce need for intubation. While face mask ventilation is an important skill, it is challenging to perform effectively. Identification of the best approach to training the use of these devices during neonatal resuscitation remains an important priority.
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Very preterm infants are at increased risk of adverse outcomes in early childhood. We assessed whether delayed clamping of the umbilical cord reduces mortality or major disability at 2 years in the APTS Childhood Follow Up Study.
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: The authors declare no conflicts of interest.

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Clinical and Laboratory ObservationCrying and Breathing by Extremely Preterm Infants Immediately After Birth

Section snippets

Methods

Results

Discussion

J Pediatr

J Pediatr

2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) of Pediatric and Neonatal Patients: Neonatal Resuscitation Guidelines

Pediatrics

International Guidelines for Neonatal Resuscitation. An Excerpt from the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science

Pediatrics

Is chronic lung disease in low birth weight infants preventable? A survey of eight centers

Pediatrics

Clinical and Laboratory Observation
Crying and Breathing by Extremely Preterm Infants Immediately After Birth