title: The first five inflations during resuscitation of prematurely born infants.
abstract: OBJECTIVE
  To study the first five inflations during the resuscitation of prematurely born infants and whether the infant's inspiratory efforts influenced the expired tidal volume.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Two tertiary perinatal centres.
  
  
  METHODS
  Thirty infants, median gestational age 30 (23-34) weeks.
  
  
  METHODS
  The first five inflations delivered via a face mask and t-piece device were examined using respiratory function monitoring.
  
  
  METHODS
  Inflation pressures, inflation times and expiratory volumes were recorded and comparison made of inflations during which the infant made an inspiratory effort (active inflation) or did not (passive inflation).
  
  
  RESULTS
  Overall, the median expired tidal volume was 2.5 (0-19.8) ml/kg and was lower for passive (median 2.1 ml/kg, range 0-19.8 ml/kg) compared with active (median 5.6 ml/kg, range 1.2-12.2 ml/kg) inflations (ratio of geometric means 1.85, 95% CI 1.18 to 28%) (p=0.007). Overall, the median face mask leak was 54.5% and was lower for active (34.5%) compared with passive (60.7%) inflations (mean difference in % leak: 12.4%, 95% CI 0.9 to 24%) (p=0.0354). There was a significant positive correlation between the expiratory volumes and the inflation pressures (R2 between subjects 0.19, p=0.04) and a negative correlation between the expiratory tidal volumes and the face mask leaks (R2 between subjects=0.051, p<0.001), but there was no significant correlation between the inflation times and the expiratory tidal volumes.
  
  
  CONCLUSIONS
  The expired tidal volume, inflation pressures and times during the first five inflations during resuscitation were variable. The expired tidal volumes were significantly greater if the infant inspired during the inflation.
authors.affiliation: Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic, Mechanisms of Asthma, King's College London, UK.
authors.forename: Vadivelam
authors.initials: V
authors.lastname: Murthy
authors.forename: Nikesh
authors.initials: N
authors.lastname: Dattani
authors.forename: Janet L
authors.initials: JL
authors.lastname: Peacock
authors.forename: Grenville F
authors.initials: GF
authors.lastname: Fox
authors.forename: Morag E
authors.initials: ME
authors.lastname: Campbell
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Milner
authors.forename: Anne
authors.initials: A
authors.lastname: Greenough
mesh_terms: D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D001239:Inhalation / Q000502:physiology; D008297:Male; D008397:Masks; D008991:Monitoring, Physiologic / Q000295:instrumentation; D018743:Perinatal Care / Q000379:methods; D011175:Positive-Pressure Respiration / Q000379:methods; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods*; D013990:Tidal Volume / Q000502:physiology