title: Initial stabilisation of preterm infants: a new resuscitation system with low imposed work of breathing for use with face mask or nasal prongs.
abstract: OBJECTIVE
  T-piece resuscitation systems are pressure unstable and have high imposed work of breathing (iWOB). Pressure stable respiratory support with low iWOB might improve outcome. We have developed a new resuscitation system that can be used with nasal prongs or face mask. The aim of the study was to describe the in vitro performance of the new system and to perform a clinical feasibility trial of initial stabilisation of preterm infants.
  
  
  METHODS
  A mechanical lung model was used to determine iWOB at increasing levels of continuous positive airway pressure (CPAP). The feasibility trial included 36 infants (27-34 weeks of gestation), who were randomised into three groups (T-piece, new system with face mask or new system with prongs). Collected data included problems with usage, safety, time to stable breathing, need for positive pressure ventilation and intubation.
  
  
  RESULTS
  In the mechanical lung model, the new system reduced iWOB with 91.5% (mask) and 86.6% (medium prongs) compared with Neopuff (4 cm CPAP, p<0.001). Informed consent was obtained from 45 patients, 39 were randomised and 36 needed support. Randomisation resulted in an imbalance: The group of new system infants had lower gestational age compared with the T-piece group. Thirteen patients needed positive pressure ventilation (median 20 cm H2O). One infant was intubated. The study did not reveal problems with the equipment or safety.
  
  
  CONCLUSIONS
  Compared with T-piece systems, the new system had a marked reduction in iWOB in bench tests. The feasibility trial did not reveal problems with usability or safety.
authors.affiliation: Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden.|Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Snorri
authors.initials: S
authors.lastname: Donaldsson
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.|Department of Anaesthesiology and ICU, Östersund Hospital, Östersund, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Drevhammar
authors.affiliation: Department of Paediatrics, Vaasa Central Hospital, Vaasa, Finland.
authors.forename: Leena
authors.initials: L
authors.lastname: Taittonen
authors.affiliation: Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Stina
authors.initials: S
authors.lastname: Klemming
authors.affiliation: Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden.|Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Baldvin
authors.initials: B
authors.lastname: Jonsson
mesh_terms: D001034:Apgar Score; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007224:Infant Care / Q000379:methods*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D008297:Male; D008397:Masks; D008953:Models, Anatomic; D011030:Pneumothorax / Q000209:etiology; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D012151:Resuscitation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D014939:Work of Breathing / Q000502:physiology*
keywords: Continuous positive airway pressure; Infant, premature; Positive pressure ventilation; Resuscitation