Text III. Positive Pressure Ventilation

Infants with rates less than 100 beats per minute need high-quality ventilation with oxygen-enriched gas immediately, as do infants who remain apneic for more than one minute after birth. With effective ventilation, the heart rate should increase to over 100 beats per minute within 15 to 30 seconds. The first few insufflations may require pressure of 30 to 50 cm of water. Thereafter, lower pressures should suffice unless lung disease is present.

Bag mask ventilation:

a) With the infant’s head slightly extended, the mask is grasped with the thumb and first two fingers of the left hand and placed gently but firmly over the infant’s mouth and nose. The other two fingers of the left hand are used to support the chin.

b) We usually use our continuous positive airway pressure (CPAP) device to deliver oxygen-enriched gas and to ventilate newborns. Self inflating devices also work well.

c) A ventilatory rate of 30 to 50 per minute is usually adequate.

d) The effectiveness of ventilation is assessed by observation of chest motion and a prompt increase in heart rate. Auscultation of the chest should reveal air entry bilaterally.

e) Gastric distention should be watched for and may be relieved by passing a nasogastric or orogastric tube.

Endotracheal intubation. The need for intubation during resuscitation of newborn infants has often been an artifact of the supine position. In this position, the large occiput and tongue and small posterior pharynx combine to produce airway obstruction. Endotracheal intubation is indicated:

a) if bag and mask ventilation is ineffective;

b) if airway obstruction is suspected (e.g., gointer or micrognathia);

c) if meconium aspiration is suspected;

d) if external cardiac massage is necessary;

e) if prolonged ventilatory support is anticipated.

The majority of infants with cardiorespiratory depression may be resuscitated by high-quality ventilation alone.

26. Read text IV and say what the main idea of the text is: