Elsevier

Resuscitation

Volume 81, Issue 3, March 2010, Pages 327-330
Resuscitation

Clinical paper
Delivery room resuscitation of near-term infants: Role of the laryngeal mask airway

https://doi.org/10.1016/j.resuscitation.2009.11.005Get rights and content

Abstract

Aim

This observational study aims to describe: (1) the use of positive pressure ventilation (PPV) for resuscitation in the delivery room among newly born near-term infants; (2) the methods used for PPV resuscitation [e.g., bag–facial mask (BFM), laryngeal mask airway (LMA), endotracheal tube (ETT)]; and (3) the association of each device with short-term neonatal outcomes.

Methods

We identified near-term (34 0/7–36 6/7 weeks) infants delivered at the Padua University Hospital (Padua, Italy) during the years 2002–2006. The mode of delivery, gestational age, birth weight, Apgar scores, methods of resuscitation and respiratory outcome after NICU admission were analysed.

Results

During the 5-year study period, 921 (4.9%) near-term infants were identified from a total of 18,641 live births. PPV was provided in the delivery room to 86 (9.3%) of these infants. Among them, 36 (41.8%) were managed by LMA, 34 (39.5%) by BFM and 16 (18.6%) by ETT. Thirty-four (39.5%) resuscitated near-term infants were admitted to the Neonatal Intensive Care Unit (NICU): 15 (44.1%) after BFM, 12 (75%) after ETT and seven (19.4%) after LMA. Resuscitation with an ETT was associated with an increased rate of respiratory distress syndrome when compared with either BFM or LMA. Resuscitation with an LMA was associated with a lower rate of NICU admission and shorter length of stay when compared with either BFM or ETT.

Conclusion

The LMA is an effective device for primary airway management of near-term infants and for secondary airway management among near-term infants failing BFM or ETT resuscitation.

Section snippets

Patients and methods

We searched the electronic medical records of all infants delivered at the Padua University Hospital (Padua, Italy) between January 2002 and December 2006 (inclusive) to identify those delivered near-term, 34 0/7–36 6/7 weeks’ gestation, based on best obstetric estimates. The Padua University Hospital is a tertiary teaching hospital with approximately 4000 births and 350 admissions to the Neonatal Intensive Care Unit (NICU) each year. The records of all near-term infants who required PPV for

Results

During the 5-year study period, 18,641 live births were recorded including 921 infants (4.9%) delivered between 34 0/7 and 36 6/7 weeks’ gestational age. The annual proportion of near-term infants ranged from 3.1% to 5.9% (Table 1). Eighty-six of the near-term infants (9.3%, range: 4.4–24.1%) were resuscitated with PPV in the delivery room and form the study group for this review (Table 1).

Resuscitators chose to provide PPV with the BFM and LMA devices most frequently. LMA was used in 36

Discussion

Premature birth is known to place infants at increased risk for both mortality and morbidity compared with infants who are born at term.14 A subgroup of ‘near-term’ or ‘late premature’ infants (34–36 6/7 weeks’ gestation) have recently become the focus of increased interest since they manifest signs of physiologic immaturity and delayed transition despite relatively large size and apparent functional maturity.14, 19 In the neonatal period, these infants have an increased risk for medical

Conclusions

In a single unit with appropriate training and guidelines, the LMA can be used at a clinician's discretion to deliver PPV effectively to infants delivered between 34 and 37 weeks’ gestation. This may be due to the experience and confidence that our physicians have developed with this device and the individualised approach implemented in our delivery room. Prospective randomised trials are needed to confirm the potential advantages of the LMA in neonatal resuscitation of near-term infants.26

Conflict of interest

No conflict of interest.

References (26)

  • V. Zanardo et al.

    Breastfeeding success after laryngeal mask airway resuscitation

    J Matern Fetal Neonatal Med

    (2009)
  • J.R. Brimacombe et al.

    Resuscitation of neonates with the laryngeal mask – a caution

    Pediatrics

    (1995)
  • T.N. Raju et al.

    Optimizing care and outcome for late-preterm (near-term) infants: a summary of the workshop sponsored by the National Institute of Child Health and Human Development

    Pediatrics

    (2006)
  • Cited by (40)

    • 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

      2022, Resuscitation
      Citation Excerpt :

      The full text of this CoSTR can be found on the ILCOR website.226 The SysRev identified 5 RCTs227–231 and 1 quasi-RCT232 involving a total of 1857 newborn infants and 2 retrospective cohort studies233,234 involving 218 newborn infants. An additional study235 reported secondary outcomes from a subset of newborn infants enrolled in an included RCT.228

    • The Pediatric Airway

      2019, A Practice of Anesthesia for Infants and Children
    • Respiratory and Cardiovascular Support in the Delivery Room

      2018, The Newborn Lung: Neonatology Questions and Controversies, Third Edition
    • The Pediatric Airway

      2018, A Practice of Anesthesia for Infants and Children
    • Supreme Laryngeal Mask Airway versus Face Mask during Neonatal Resuscitation: A Randomized Controlled Trial

      2015, Journal of Pediatrics
      Citation Excerpt :

      All these studies enrolled patients with gestational age ≥34 weeks and birth weight >2000 g.14 These inclusion criteria were in agreement with International Liaison Committee on Resuscitation recommendations.1,2 Based on previous observational studies,10-12 we included smaller patients (birth weight >1500 g) because this population is more frequently in need of resuscitation in delivery room. Our results suggest that the SLMA can be effectively and safely used also in patients with a birth weight <2000 g.

    View all citing articles on Scopus

    A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2009.11.005.

    View full text