title: Ventilation fraction during the first 30s of neonatal resuscitation.
abstract: Approximately 5% of newborns receive positive pressure ventilation (PPV) for successful transition. Guidelines urge providers to ensure effective PPV for 30-60s before considering chest compressions and intravenous therapy. Pauses in this initial PPV may delay recovery of spontaneous respiration. The aim was to find the ventilation fraction during the first 30s of PPV in non-breathing babies.
  
  
  
  Prospective observational study in two hospitals in Norway. All newborns receiving PPV immediately after delivery were included. Cameras with motion detectors were installed at every resuscitation bay capturing both expected and unexpected compromised newborns. We determined the cumulative number of seconds with PPV efforts excluding pauses in infants without spontaneous breathing and reported ventilation fraction during the first minute. Data are presented as median (IQR).
  
  
  
  110 of 3508 (3%) newborns received PPV and were filmed in the resuscitation bays. PPV started 42 (18-78)s after arrival at the resuscitation bay and median duration was 100 (35-225)s. Forty-eight infants (44%) were ventilated continuously, or with minimal pause (ventilation fraction >90%) during the first 30s of PPV. For the remaining 62 infants ventilation fraction was 60% (39-75). PPV was interrupted due to adjustments, checking heart rate, stimulation, administration of CPAP and suctioning.
  
  
  
  In 56% of the neonatal resuscitations interruptions in ventilation are frequent with 60% ventilation fraction during the first 30s of PPV. Eliminating disruption for improved quality of PPV delivery should be emphasized when training newborn resuscitation providers.
authors: Norwegian National Advisory Unit for Prehospital Emergency Care (NAKOS) and Department of Anaesthesiology, Oslo University Hospital and University of Oslo, Oslo, Norway. Electronic address: christiane.skare@medisin.uio.no.
authors: Christiane
authors: C
authors: Skåre
authors: Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine Campus Ahus, University of Oslo, Lørenskog, Norway.
authors: Anne-Marthe
authors: AM
authors: Boldingh
authors: Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine Campus Ahus, University of Oslo, Lørenskog, Norway.
authors: Britt
authors: B
authors: Nakstad
authors: Neonatal Intensive Care Unit, Oslo University Hospital, Oslo, Norway.
authors: Tor Einar
authors: TE
authors: Calisch
authors: Center for Simulation, Advanced Education and Innovation, The Children's Hospital in Philadelphia, Philadelphia, USA.
authors: Dana E
authors: DE
authors: Niles
authors: Department of Anesthesia, Critical Care and Pediatrics, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, USA.
authors: Vinay M
authors: VM
authors: Nadkarni
authors: Norwegian National Advisory Unit for Prehospital Emergency Care (NAKOS) and Department of Anaesthesiology, Oslo University Hospital and University of Oslo, Oslo, Norway.
authors: Jo
authors: J
authors: Kramer-Johansen
authors: Norwegian National Advisory Unit for Prehospital Emergency Care (NAKOS) and Department of Anaesthesiology, Oslo University Hospital and University of Oslo, Oslo, Norway.
authors: Theresa M
authors: TM
authors: Olasveengen
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D020380:Needs Assessment; D009664:Norway / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D011175:Positive-Pressure Respiration; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D058996:Quality Improvement; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology / Q000628:therapy*; D061665:Time-to-Treatment / Q000458:organization & administration / Q000592:standards; D014741:Video Recording / Q000379:methods
keywords: Education; Neonatal resuscitation; Positive pressure ventilation