Delivery room resuscitation of near-term infants: role of the laryngeal mask airway.
OBJECTIVE
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.


CONCLUSIONS
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.
Zanardo
Vincenzo
V
Department of Paediatrics, School of Medicine, Padua University, Padua, Italy. zanardo@pediatria.unipd.it
Weiner
Gary
G
Micaglio
Massimo
M
Doglioni
Nicoletta
N
Buzzacchero
Ramona
R
Trevisanuto
Daniele
D
D003696:Delivery Rooms; D005145:Face; D006801:Humans; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D017214:Laryngeal Masks / Q000592:standards; D008397:Masks; D011175:Positive-Pressure Respiration / Q000295:instrumentation; D012151:Resuscitation / Q000295:instrumentation* / Q000379:methods; D047929:Term Birth; D016896:Treatment Outcome