title: Monitoring lung aeration during respiratory support in preterm infants at birth.
abstract: BACKGROUND
  If infants fail to initiate spontaneous breathing, resuscitation guidelines recommend respiratory support with positive pressure ventilation (PPV). The purpose of PPV is to establish functional residual capacity and deliver an adequate tidal volume (VT) to achieve gas exchange.
  
  
  OBJECTIVE
  The aim of our pilot study was to measure changes in exhaled carbon dioxide (ECO2), VT, and rate of carbon dioxide elimination (VCO2) to assess lung aeration in preterm infants requiring respiratory support immediately after birth.
  
  
  METHODS
  A prospective observational study was performed between March and July 2013. Infants born at <37 weeks gestational age who received continuous positive airway pressure (CPAP) or PPV immediately after birth had VT delivery and ECO2 continuously recorded using a sensor attached to the facemask.
  
  
  RESULTS
  Fifty-one preterm infants (mean (SD) gestational age 29 (3) weeks and birth weight 1425 (592 g)) receiving respiratory support in the delivery room were included. Infants in the CPAP group (n = 31) had higher ECO2 values during the first 10 min after birth compared to infants receiving PPV (n = 20) (ranging between 18-30 vs. 13-18 mmHg, p<0.05, respectively). At 10 min no significant difference in ECO2 values was observed. VT was lower in the CPAP group compared to the PPV group over the first 10 min ranging between 5.2-6.6 vs. and 7.2-11.3 mL/kg (p<0.05), respectively.
  
  
  CONCLUSIONS
  Immediately after birth, spontaneously breathing preterm infants supported via CPAP achieved better lung aeration compared to infants requiring PPV. PPV guided by VT and ECO2 potentially optimize lung aeration without excessive VT administered.
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Canada; Neonatal Research Unit, Royal Alexandra Hospital, Alberta Health Services, Edmonton, Canada.
authors.forename: Liane J
authors.initials: LJ
authors.lastname: Kang
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Canada; Neonatal Research Unit, Royal Alexandra Hospital, Alberta Health Services, Edmonton, Canada.
authors.forename: Po-Yin
authors.initials: PY
authors.lastname: Cheung
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Canada; Neonatal Research Unit, Royal Alexandra Hospital, Alberta Health Services, Edmonton, Canada; Division of Neonatology, Department of Pediatrics, Medical University, Graz, Austria.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Pichler
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Canada; Neonatal Research Unit, Royal Alexandra Hospital, Alberta Health Services, Edmonton, Canada.
authors.forename: Megan
authors.initials: M
authors.lastname: O'Reilly
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Canada; Neonatal Research Unit, Royal Alexandra Hospital, Alberta Health Services, Edmonton, Canada.
authors.forename: Khalid
authors.initials: K
authors.lastname: Aziz
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Canada; Neonatal Research Unit, Royal Alexandra Hospital, Alberta Health Services, Edmonton, Canada; Division of Neonatology, Department of Pediatrics, Medical University, Graz, Austria.
authors.forename: Georg M
authors.initials: GM
authors.lastname: Schmölzer
mesh_terms: D001794:Blood Pressure; D002245:Carbon Dioxide / Q000378:metabolism*; D006339:Heart Rate; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D011175:Positive-Pressure Respiration / Q000379:methods*; D047928:Premature Birth / Q000503:physiopathology*; D011446:Prospective Studies; D066232:Pulmonary Elimination / Q000502:physiology; D056152:Respiratory Rate; D018709:Statistics, Nonparametric; D013990:Tidal Volume / Q000502:physiology*
chemical_list: D002245:Carbon Dioxide