Predictors for expired CO2 in neonatal bag-mask ventilation at birth: observational study

BackgroundExpired carbon dioxide (ECO2) indicates degree of lung aeration immediately after birth. Favourable ventilation techniques may be associated with higher ECO2 and a faster increase. Clinical condition will however also affect measured values. The aim of this study was to explore the relativ...

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Published in:BMJ paediatrics open 2019-09, Vol.3 (1), p.e000544-e000544
Main Authors: Holte, Kari, Ersdal, Hege Langli, Eilevstjønn, Joar, Thallinger, Monica, Linde, Jørgen, Klingenberg, Claus, Holst, Rene, Jatosh, Samwel, Kidanto, Hussein, Stordal, Ketil
Format: Article
Language:English
Subjects:
Apgar score
Birth weight
Births
Carbon dioxide
Gestational age
Heart rate
Midwifery
Neonatology
Newborn babies
Observational studies
Pediatrics
Vagina
Ventilators
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Summary:BackgroundExpired carbon dioxide (ECO2) indicates degree of lung aeration immediately after birth. Favourable ventilation techniques may be associated with higher ECO2 and a faster increase. Clinical condition will however also affect measured values. The aim of this study was to explore the relative impact of ventilation factors and clinical factors on ECO2 during bag-mask ventilation of near-term newborns.MethodsObservational study performed in a Tanzanian rural hospital. Side-stream measures of ECO2, ventilation data, heart rate and clinical information were recorded in 434 bag-mask ventilated newborns with initial heart rate 2%.ResultsECO2 rose non-linearly with increasing expired tidal volume up to >10 mL/kg, and sufficient tidal volume was critical for the time to reach ECO2 >2%. Ventilation frequency around 30/min was associated with the highest ECO2. Higher birth weight, Apgar scores and initial heart rate were weak, but significant predictors for higher ECO2. Ventilation factors explained 31% of the variation in ECO2 compared with 11% for clinical factors.ConclusionsOur findings indicate that higher tidal volumes than currently recommended and a low ventilation frequency around 30/min are associated with improved lung aeration during newborn resuscitation. Low ECO2 may be used to identify unfavourable ventilation technique. Clinical factors are also associated with persistently low ECO2 and must be accounted for in the interpretation.
ISSN:2399-9772
DOI:10.1136/bmjpo-2019-000544