Corrective ventilation strategies in delivery room resuscitation of preterm infants

Abstract

Aim: Corrective ventilation strategies (CVS) during neonatal resuscitation and stabilisation (R&S) are taught through the MRSOPA mnemonic: Mask adjustment, Repositioning airway, Suctioning, Opening the mouth, Increasing inspiratory Pressure, and Alternative airway. The aim was to examine the use of CVS and to investigate the relationship between MRSOPA strategies and intubation of very preterm infants <32 weeks' gestation in the delivery room.

Methods: Retrospective review of video recordings of R&S of preterm infants born in Cork University Maternity Hospital, Ireland.

Results: In 46 resuscitation recordings, mask adjustment was observed in almost all (95.6%), followed by suctioning, (23.9%), opening the mouth (100%), increasing inspiratory pressure (81.0%) and intubation (32.6%). The most frequently used mask holds were: one-handed (95.6%), two-handed (63.0%), stem hold (23.8%), and modified spider hold (6.5%). There were no significant associations between individual mask holds and intubation. The more CVS employed the greater the need for intubation.

Conclusion: The greater the number of MRSOPA strategies used in the delivery room, the more likely intubation occurred. Further studies may identify the effect of these CVS on short- and long-term outcomes, in order to enhance R&S training and clinical practice.

Keywords: Mask hold; Neonatal resuscitation; Neonate; Prematurity.