Advancements and challenges in neonatal resuscitation: embracing laryngeal mask airways for improved outcomes
Article information
Key message
Positive pressure ventilation (PPV) is the most critical intervention provided during delivery room resuscitation. In the new guidelines, this recommendation has been expanded to suggest the use of laryngeal mask airyway (LMA) versus face masks for PPV. Evidence-based information and hands-on training related to this practice will help more healthcare providers become familiar with and appropriately use LMA during delivery room resuscitations.
Despite advancements in perinatal medicine, the prevention of hypoxic-ischemic encephalopathy through appropriate neonatal resuscitation remains a major issue in neonatology. While 90% of all neonates successfully transition from fetal to neonatal life without requiring special assistance during the birth process, 10% require some level of resuscitative intervention and 1% require extensive neonatal resuscitation [1].
Neonatal resuscitation is an essential clinical competency for medical professionals in the field of perinatal medicine. Unlikely adult cardiac life support, which is primarily required due to cardiac issues, neonatal resuscitation is typically required due to ventilation issues. Therefore, positive pressure ventilation (PPV) is the most critical intervention provided during delivery room resuscitation, and its application frequency varies according to the neonate’s gestational age and other factors. In previous studies, 3.6%–8.1% [2-5] of all in- or liveborn infants required PPV at birth; of them, younger preterm infants had greater need [6]. Fig. 1 shows a flow chart of the newly updated neonatal resuscitation algorithm [7].
Neonatal resuscitation algorithm. CPAP, continuous positive airway pressure; ECG, electrocardiography; ETT, endotracheal tube; HR, heart rate; IV, intravenous; O2, oxygen; SpO2, oxygen saturation; UVC, umbilical venous catheter. Reproduced with from Aziz K, et al. Circulation 2020;142(16_suppl_2):S524-50,7) with permission of American Heart Association, Inc., and American Academy of Pediatrics.
Yamada et al. [8] analyzed errors occurring during neonatal resuscitation through video recordings and found that the second most common error of commission (at 43.5%) was performing PPV with insufficient peak inspiratory pressure or providing inappropriate peak inspiratory or positive end-expiratory pressure.
The 7th edition of the American Neonatal Resuscitation Program guidelines [9] recommended the use of a laryngeal mask airway (LMA) as an alternative to an endotracheal tube in neonates weighing more than 2 kg. In the new guidelines [10], this recommendation has been expanded to suggest the use of LMA versus face masks for PPV. In this context, Song and Jeon [11] reviewed its routine for PPV. Neonatal resuscitation education provided by medical institutions and professional societies must include evidence-based information and hands-on training related to this practice. Such education will help more healthcare providers become familiar with and appropriately use LMA during delivery room resuscitations. Furthermore, additional clinical research is needed to provide evidence of the efficacy of LMA in smaller and more premature infants.
Notes
Conflicts of interest
No potential conflict of interest relevant to this article was reported.
Funding
This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.