Neonatal positive pressure ventilation and initial oxygen use
THE CONTEXT
Positive pressure ventilation (PPV) supports newborns with inadequate breathing or a heart rate below the stated threshold. Equipment, oxygen concentration, and mask placement require attention.
Equipment and indications
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Provide PPV using a self-inflating bag and face mask, termed bag and mask ventilation. The bag reinflates without an external compressed gas source.
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The resuscitation bag should have a capacity of 240–750 mL and should connect to oxygen, air, and a blender to provide the desired oxygen concentration.
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PPV is indicated if the infant is apneic or gasping, or if the heart rate is below 100 beats per minute.
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Bag and mask ventilation is contraindicated in suspected or confirmed diaphragmatic hernia.
Oxygen selection and adjustment
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Both insufficient and excessive oxygen can harm the baby; even brief exposure to a high oxygen concentration can be detrimental.
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Term neonates resuscitated with room air have better survival and long-term outcomes than those resuscitated with 100% oxygen.
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Start resuscitation with room air for neonates of at least 35 weeks of gestation and with 21–30% oxygen for those below 35 weeks.
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Monitor oxygen saturation with pulse oximetry and titrate oxygen to the targeted saturation range. A lower initial oxygen concentration helps prevent hyperoxia-related bronchopulmonary dysplasia and retinopathy of prematurity.
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Without pulse oximetry, replace room air with 100% oxygen if heart rate and breathing fail to improve by 90 seconds.
Position and mask fit
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Stand at the head or side of the neonate with a clear view of the chest and abdomen.
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Keep the neck neutral or slightly extended.
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Choose a face mask that covers the mouth and nose without covering the eyes.